
Class. 
Book 



COPYRIGHT DEPOSIT 



DISEASES OF MAN: 



DATA OF THEIR 



NOMENCLA TURE, CLASSIFICA TION 6- GENESIS. 



J 



TO DESCRIBE IS TO PARTICULARISE. 
" Words are the fortresses of thought." 
" In words are contained the sciences possessed by the 
nations of the earth " 

TO DEFINE IS TO GENERALISE. 

Definition is the summary of description. 
" Perfect definition is the summit of human knowledge in 
every part of science " 

"TO NAME IS TO KNOW." 

" The true progress of science must always be realised in 
names." 

"Things are known when understood and are understood 
when interpreted." 

"The perfection of a science depends, in no inconsiderable 
degree, upon the perfection of its language; and the perfec- 
tion of every language upon its simplicity and precision." 

"TO THINK IS TO CLASSIFY," 

and to classify is to think. 

" System is the Ariadnean thread without which all is con- 
fusion." 

" Classification is not attainable by art only, it requires a 
mind that is capable of distinguishing things by their specific 
differences ; not separating things that are alike nor blending 
things that are different." 



DISEASES OF MAN: 



DATA OF THEIR 



NOMENCLATURE, CLASSIFICATION &* GENESIS. 



BY 

JOHJST W. SrGOULEY, M.D., 
Surgeon to Bellevue Hospital. 









NEW YORK : 
J. H. Vail & Co., 21 Astor Place. 

LONDON : 

H. K. Lewis, 136 Gower Street. 
1888. 



NO 
>0 



<*v 



Copyright, 1888. 
By j. w. s. Gouley. 



PREFACE. 

The objects of this book are ; first, to urge the 
official adoption of a stable basis for the nomen. 
clature and classification of the diseases of man ; 
second, to place before the medical profession 
certain propositions directed to an improved 
classification of diseases ; and third, to awaken 
the attention of teachers to the necessity of 
ameliorating the nomenclature of medicine, 
pointing out some of the many misused and im- 
properly formed words that are now current, 
and proposing new terms for their considera- 
tion. 



6 PREFACE. 

In attempting to classify the affections of the 
male uro-genital apparatus, it was found diffi- 
cult to do so satisfactorily, owing to the defects 
of the existing nomenclature. This led to an 
inquiry into the former and actual state of nos- 
onomy and nosotaxy, and into the methods em- 
ployed by nosographers from the time of 
Sauvages to the present. The conclusion ar- 
rived at, is that a nomenclature and classification 
to be useful and stable should not only rest 
upon a proper foundation, but should be duly 
authorised by the whole profession of medicine. 
The principles deduced from an analysis of the 
methods of nomenclators and classifiers are now 
submitted to the profession ; and certain ques- 
tions are suggested for discussion in, and for 
settlement by, the International Medical Congress 
which properly represents the medical profes- 
sion. 

The presentation of this subject to the profes- 
sion is designed as a plea for the more systematic 



PREFACE. 7 

study of diseases, and as an individual protest 
against their existing nomenclature and classfica- 
tion, with the hope that this protest will become 
general among teachers and others who realise 
the necessity of bettering the condition of 
medicine, without undertaking to destroy its 
fabric in order to reconstruct it; but rather to 
modify, simplify, and improve it by gradually 
substituting exact terms for those that have 
never conveyed correct ideas. 

During the preparation of this book, more 
or less frequent consultations were held with 
Doctors Clymer, Carroll, Flint, Biggs, Cronyn, 
Taylor, Clark, Leale, Grauer, John Shrady, 
Edmund Arnold, and others. The valuable sug- 
gestions of these kind friends are gratefully 
acknowledged. 

Botanists, Mineralogists, Biochemists and Phi- 
lologists have been consulted with much advant- 
age and their hints have been thankfully received 
and carried. out. 



8 PREFACE. 

Works on Botany, Zoology, General Chemis" 
try, Biochemistry, Physiology, Descriptive Anat- 
omy, General and Special Pathology, and Sur- 
gery, and many of the treatises on nomenclature 
and classification have been freely used. A 
general acknowledgment is made to the authors 
of these works which have been of the greatest 
service in this endeavor to elucidate the princi- 
ples of nosonomy and nosotaxy. 

324 Madison Avenue, 
New-York, January 1888. 



* 



CONTENTS. 

PREFACE page 5-8 

CORRIGENDA, "12 

INTRODUCTION, "13-24 

SECTION I. 
Preliminary Considerations. 

Outline of the anatomical view of man. Definition of med- 
icine. A classification of the science and art of medicine. 
Medicine and Surgery. Arrangement of medicine into certain 
departments in accordance with the apparatuses of the human 
body. The physician. Definition of disease. A synopsis of 
the morbid states and morbific processes of the body. The 
value and significance of proper anatomical terms in classi- 
fication. Definition of system, organ, apparatus, and function. 
Systems and organs perform no function, but yield service to 
apparatuses. Each apparatus performs only one function, 
and there is no function without an apparatus, . page 25-72 



IO CONTENTS. 

SECTION II. 
Human Nosography. 

A summary of the progress of nosography since its founda- 
tion. The scope of nosography. Notice of Sauvages. A 
consense of views necessary in methodical arrangement. 
Synopses of Sauvages', Cullen's, Parr's. Good's, and Delorme's 
arrangements of diseases. Comments on these several sys- 
tems. Cullen's rules for distinguishing genera, species, and 
varieties of diseases. Parr's rules. Some of the aphorisms, 
relating to classification, extracted principally from the phil- 
osophia botanica of Linnaeus, by Dr. Thomas Young, 

page 73~ l 99 

SECTION III. 

NOSOGRAPHICAL BIBLIOGRAPHY. 

A chronological list of the works on nosography that have 
appeared from the time of Felix Platerus to the present, 

page 200-211 

SECTION IV. 

Basis and Method of the Classification and 

Character of the Nomenclature of 

the Diseases of Man. 

Many high authorities opposed to classification. To think 
is to classify. Characteristics of good classifiers. Modern 
classifiers use terms of classification arbitrarily without taking 
the pains to define these terms. Nosography on the basis of 
symptoms misleading and retrogressive. Anatomy the only 
stable basis for nosography. Description and definition of dis- 



CONTENTS. 1 1 

cases. Methods of the nosographer. The use of the dead 
languages in nomenclature. The names of men should not 
be applied to diseases. Suggestions for an improved classifi- 
cation of diseases. A consense of views necessary in the use 
of terms of classification. Questions suggested for discussion 
at the Tenth International Medical Congress. Definitions of 
the terms of classification, .... page 212-252 

SECTION V. 

Review of the Morbid States and Morbific 

Processes. The Bacteria. Ptomaines, 

Leucomaines, and Extractives. 

Analysis of some of the terms used in general pathology 
and of those contained in the synopsis of morbid states and 
morbific processes, together with remarks on these states and 
processes. Summary of the present state of knowledge of 
the bacteria, ptomaines, leucomaines, and *' extractives." 
The relations borne, to medicine and surgery, by these micro- 
organisms and alkaloids of putridity. Classifications of the 
bacteria, ptomaines, and leucomaines. Uniformity in their 
nomenclature and classification much needed. Remarks on 
the neoplasams and on their classification, - page 253-379 

CONCLUSIONS, - 380 



CORRIGENDA 

Page 36, second line, for propylactic, read prophylactic. 

" 40, foot note, for celibary, read celibacy. 

" 48, V. 8, for (obsteoma), read (osteoma). 

" 56, foot note, for eyyevyS, read eyyevrjS. 

" 63, " " for opyavov, read opyavov. 

" 67, tenth line, for antonomous, read autonomous. 

" 69, fifth line from bottom, for corect, read correct. 

" 102, IX. I., for sangninfluxus, read sanguifluxus. 

" 150, fourth line, for cornea, read cornea. 

" 212, first line, for authorites, read authorities. 

" 255, foot note, for iito, read vito. 

" 326, " " " " " " 

" 365, third line from bottom, for caoiS, read ootitS. 
For Laenec read Laennec. 



13 
INTRODUCTION. 



i. This book is divided into five sections. The 
first section comprises : some anatomical consid- 
erations of the normal human body; a statement 
of the objects and scope of medicine ; a classifica- 
tion of medicine ; the mutual relations of medi- 
cine and surgery ; an arrangement of medicine 
into departments in accordance with the appara- 
tuses of the human body ; the definition and 
genesis of disease ; a synopsis of the morbid 
states and morbific processes of the body, de- 
signed as a suggestion of a ground-work for the 
classification of diseases; and an analysis of some 
of the anatomical terms used in classification. 
The synopsis of morbid states and morbific pro- 
cesses stops at genera, but a few species are given 
in foot-notes. 

The second section relates to the history, de- 
velopment, scope and significance of human 
nosography, and contains synopses of a considera- 
ble number of systematic arrangements of dis- 
eases, illustrative of the principles of nomencla- 
ture and classification, and also rules for the 
guidance of nosographers by Cullen, Parr, Young 
and Linnaeus. 



14 INTRODUCTION. 

The third section consists of a nosographical 
bibliography, chronologically arranged, from the 
time of Felix Platerus. 

The fourth section is devoted to the elucida- 
tion of what is conceived to be a proper basis, 
character, and method of the nomenclature and 
classification of the diseases of man : and to the 
definitions of the terms of classification. 

The fifth section is intended as further explana- 
tions of the morbid states and morbific processes, 
and as an analysis of some of the terms used in 
general pathology, besides which it embodies a 
summary of the present state of knowledge of 
the bacteria, ptomaines, leucomaines, and " ex- 
tractives," and indicates the relations borne, to 
medicine and surgery, by these microorganisms 
and toxic alkaloids of putridity, and finally re- 
marks on the neoplasms and on their classifica- 
tion. 

2. This work is undertaken with the hope that 
it will induce all those devoted laborers in the 
field of medical science who are struggling so 
diligently to solve great problems in physiology, 
histology, pathoanatomy, and therapy, to con- 
sider how much assistance methodical arrange- 
ment will afford them in their investigations and 
how much of their time will thereby be saved I 



INTRODUCTION. IS 

also how important it will be for them to adopt a 
correct and uniform nomenclature. They will 
then probably reject all inexact terms and coin 
words, — " verba-fidelia " — in accordance with the 
conditions they wish to designate with precision. 

In medicine, the coinage of a new word is at- 
tended with some difficulty and requires much 
deliberation, besides the censorship of men of ex- 
perience and sound judgment. The word should 
then be submitted to the profession, whose ver- 
dict on the question of its general adoption 
should be respected. On this subject of the coin- 
age of words, Ben Jonson says : " A man coins 
not a new word without some peril, and less 
fruit ; for if it happen to be received, the praise 
is but moderate ; if refused the scorn is assured." 

At present, a very considerable part of the 
nomenclature of medicine consists of such a great 
number of inappropriate, incorrectly formed and 
misleading terms, that often it is not easy, for 
investigators, even of the same nation, writing in 
the same tongue, to understand each other. 

" It is a waste of time," says Mill, in his Exam- 
ination of Sir William Hamilton s Philosophy, " for 
a mere student of philosophy to have to learn 
the familiar use of fifty philosophic phrase- 
ologies." This applies with much force to the 
many anatomists and medical investigators who 



l6 INTRODUCTION. 

use words of their own invention which others 
are at great pains to understand. 

3. While the progress made in medical art 
during the last quarter of a century is marvelous, 
the improvement in the nomenclature has by no 
means kept pace with this great advance in the 
art of medicine. Accuracy is often attained in the 
latter while it seldom obtains in the former. If 
more attention were given to the formation of 
scientific language, much confusion and misap- 
prehension, which have the effect to impede the 
progress of medical science, would be avoided. 

The technical terms of medicine derived from 
the Latin and Greek tongues are used partly for 
the sake of brevity and partly that they may be 
understood by the medical profession of the dif- 
ferent nations that cultivate the dead languages. 
Unfortunately however the cultivation of these 
languages is too limited among physicians. As a 
consequence, many meaningless expressions and 
as many hybrid words, compounded of Latin and 
Greek and sometimes of Hebrew roots, very dis- 
tasteful to the experienced scholar and serving to 
puzzle rather than to instruct the junior student, 
are constantly used in text-books and other 
works. The few modern writers who have un- 
dertaken the task of improving the nomenclature 



INTRODUCTION. 1 7 

of medicine are little heeded, and professors in 
the great schools are still thoughtlessly dissem- 
inating false notions by the careless use of inac- 
curate expressions in their daily lectures. Many 
ancient words, however inexact and absurd, are 
adhered to with great tenacity, and innovations 
the most appropriate are resisted with an ob- 
stinacy too little in keeping with the forward 
movement of the time. Conservatism is praise- 
worthy when applied to words that have stood 
the test of years and are still adjudged good and 
proper. Those time-honored terms which convey 
ideas with precision should be jealously pre- 
served ; but that multitude of misleading expres- 
sions, to be found in the literature of medicine, 
should be speedily blotted out of coming medical 
treatises and dictionaries, and their places filled 
with well chosen and philologically correct 
words. 

If teachers in the several departments of medi- 
cine will earnestly consider this subject, and if 
each will contribute his share to the reformation, 
in another quarter of a century there will surely 
be a more uniform and exact medical language. 

The needed reformation in medical nomencla- 
ture should however be rightly directed, and 
those who undertake it should be mindful of 
Lord Bacon's precept that " It is good also, not 



1 8 INTRODUCTION. 

to try experiments ; except the necessity 

be urgent, or the utility evident : and well to 
beware that it be the reformation that draweth 
on the change ; and not the desire of change 
that pretendeth the reformation." 

4. It is improbable that the often repeated 
statement, " it is not profitable to attempt to 
change the present methods of writing and of 
teaching medicine owing to its great mutability," 
will deter nomenclators and classifiers from the 
pursuance of their investigations, but it is a fact 
that they are too little encouraged, even by those 
who realise the necessity of a radical change in 
these methods. Exact nosonomy and nosotaxy 
will surely cause greater changes and advances 
than have ever been made in medicine. To give 
correct names to diseases involves the closest in- 
quiry into their nature. It is therefore fair to 
assume that the time will come when the name 
given to each disease shall indicate its nature. 
When this good time does come, medicine will 
be taught as other sciences are taught. The con- 
sideration of the advances destined to be made 
by a methodical nosography, leads to the conclu- 
sion that it must keep pace with the advancement 
to which it has given rise, and must of necessity 
be provisional. 



INTRODUCTION. 19 

5. The inexact nomenclature of diseases, and 
the defective arrangement and inconsistencies in 
existing systems are such that it is almost im- 
possible for the student to learn medicine as he 
should ; and, in view of its continued advances, 
this will be quite impossible in a quarter of a 
century, unless a radical change be made first in 
the nomenclature of anatomy and next in the 
nomenclature and classification of diseases. L 

Without an accurate nomenclature and classi- 
fication, the one hundred and twenty thousand 
flowering plants could not have been known, nor 
could the immense number of species of animals 
be studied, and it would not have been possible 
to obtain an accurate knowledge of minerals. 
Thus Botany, Zoology, and Mineralogy, have for 
many years, taken each a high rank among the 
sciences owing to proper nomenclature and to 
methodical arrangement. 

The science of medicine will never progress as 
it should and will never be learned as it should 
be learned until it is placed upon the same foot- 
ing as that of the natural sciences. 

Without an accurate nomenclature and classi- 
fication it is very difficult for the practising phy- 
sician to have the clear understanding of diseases 
so necessary to their rational treatment. All 
morbid states of the human body should be 



20 INTRODUCTION. 

known by names that indicate their nature, and 
it is only a right conception of this nature which 
can lead to the use of appropriate remedies. 

6. The terms nomenclature and classification of 
diseases do not by themselves express with suf- 
ficient precision the scope and objects of syste- 
matic arrangement. Therefore the word nosog- 
raphy should, in its broadest sense, be employed 
to signify the whole, or some part of the science 
of medicine as, for example, human nosography, 
nosography of the uro-genital apparatus, or of 
any other apparatus of the human body. 

7. It is often said that language fails to express 
with accuracy the ideas which man conceives of 
things. Sweeping as this statement may seem, it 
is defensible, particularly in the case of medical 
language which so much needs reconstruction. 
That however which causes the greatest per- 
plexity in the expression of ideas, is the misap- 
plication of words, and also their employment in 
different senses, so as to give to each several 
meanings. Since it is not probable — at least not 
for a very long time — , that human language will 
consist of words having each a single meaning, 
the most judicious use should be made of existing 
terms and the greatest care taken in the forma- 
tion of new words; and all writers should strive 



INTRODUCTION. 21 

to give a clear exposition of their ideas by some- 
times explaining the words of many meanings 
which they are obliged to employ. Some of the 
great faults in medical language are: (i,) the 
misapplication of words; (2,) the use of improp- 
erly constructed words ; (3,) the use of words 
which do not convey an exact idea of the object 
designated ; and (4,) the use of men's names to 
designate diseases. These faults are all remedia- 
ble, but to repair them most effectually and to 
prevent their recurrence, a consense of views in 
the medical profession is absolutely necessary ; 
then the changes in terms will be uniform, will 
come authoritatively, and will therefore be ac- 
cepted. < 

It appears that medicine is not the only science 
whose progress has been hindered by abuses in 
terms. 

In his Elements of the Philosophy of the Human 
Mind, Dugald Stewart says : " When I consult 
Johnson's Dictionary, I find many words of which 
he has enumerated forty, fifty, or even sixty dif- 
ferent significations ; and, after all the pains he 
has taken to distinguish these from each other, I 
am frequently at a loss how to avail myself of his 
definitions." 

A great thinker and metaphysician comments, 



22 INTRODUCTION. 

as follows, upon words and deplores their wrong 
usage. 

" In words are contained the knowledge 

and sciences possessed by the nations of the 

earth A strict adherence to propriety in 

the use of words, is the only means for maintain- 
ing clearness of ideas, for preserving and har- 
monising them Many ancient and modern 

sophists, and many profane philosophers, sought 
artfully to alter the true value and force of 
words. The world could scarcely be deceived 
except by such alteration. Abuse has been made 
of almost all philosophical and political terms, as 
has been frequently shown by various writers. 
Whoever takes note of the errors that have arisen 
from the abuse of the word Nature, in the 
sciences of Right and Politics — of the words 
Sensation, Pleasure, Pain, in Metaphysics ; of the 
words Equality and Liberty in Politics; of the 
word Wealth in Political Economy — and of the 
many others to which, generally, there has been 
added only a more extensive signification than 
that given them by common usage, will discover 
the sources of incredible deceptions to the mind, 
and of incredible evils to humanity." (Rosmini, 
Introduzione alia Filosojia.) 

I Max Miiller in his Science of Thought, 1887, (p. 
18) says : " That every one of these words 



INTRODUCTION. 23 

is used in different senses by different philoso- 
phers, might be tolerated, if each philosopher 
would tell us clearly, and once for all, in what 
sense he himself means to use them. This is 
what few attempt to do; and if they do it, they 
often seem to imagine that because there are so 
many words, there must be also so many distinc- 
tions. They overburden us with definitions and 
make confusion worse confounded."/ 

The following, which is much to the purpose 
is also quoted from the recent work of Max 
Miiller. 

11 All I maintain is that, not only to a considera- 
ble extent, but always and altogether, we think 
by means of names, and that things are no more 
to us than what we mean by their names. What 
we really mean by names must be settled by defi- 
nition, and according as our knowledge changes, 
the definition and therefore the meaning of names 
will change. Every new addition to our ex- 
perience may be said to change, to correct, or to 
complete the intension and the extension of our 
names, but before we can use our new knowledge, 
it must always have been embodied either in an 

old or a new name There may be little or 

much, there may be false or true knowledge in 
our names, but without some sort of name we 
cannot reason." (p. 35, Science of Thought.) -* 



24 INTRODUCTION. 

8. As a means to the desired end, students of 
medicine should be thoroughly drilled in the use 
of words of precision, whose employment is 
coupled with exact knowledge, — not forgetting 
the fact that to name is to know, for these two 
words have been traced to the same root whose 
antiquity is almost as great as that of man — , and 
exact medical knowledge, methodically arranged, 
will inevitably lead to its practical application in 
the cure of disease or the alleviation of human 
suffering. High as is the achievement of curing 
disease or of alleviating suffering, the physician 
should aspire to the still higher object of preserv- 
ing the health of the people. This should be the 
end of medicine. 



PRINCIPLES 

OF 

NOMENCLATURE AND CLASSIFICATION. 



SECTION I. 

Preliminary Considerations. 

Outline of the anatomical view of man. Definition of medi- 
cine. A classification of the science and art of medicine. 
Medicine and Surgery. Arrangement of medicine into certain 
departments in accordance with the apparatuses of the human 
body. The physician. Definition of disease. A synopsis of 
the morbid states and morbific processes of the body. The 
value and significance of proper anatomical terms in classifi- 
cation. Definition of system, organ, apparatus, and function. 
Systems and organs perform no function, but yield service to 
apparatuses. Each apparatus performs only one function, 
and there is no function without an apparatus. 

THE HUMAN BODY. 

Anatomically considered man's body is a 
grand complex apparatus destined to perform 
the one function of reproduction of its species. 
To that end the male and female must couple. 
The sperm of the male then fecundates the ovum 



26 THE HUMAN BODY. 

which is within the female, and SHE completes 
the function of reproduction of the species. *? 

This primary human apparatus is an assem- 
blage of secondary apparatuses that are intended 
to perform certain special functions, some of 
which are designed to conserve the individual, 
and others to keep the body in a health)^ condi- 
tion and fit it for the performance of its one great 
function. 

The senses of man, each of which being the 
function of a special apparatus, are all subservi- 
ent to the genetic sense, to the one paramount 
function, requiring the union of the sexes for its 
accomplishment. 

Such are the facts that may be gleaned from 
anatomy, but archaeology too teaches its lesson. 
It appears that many of the ancient nations made 
the external genital organs of both sexes objects 
of worship, so much importance did they attach 
to generation, and that traces of phallic worship 
have been discovered within a comparatively re- 
cent period, even among the savage tribes of the 
South Sea Islands, and of North, Central, and 
South America. 

Anatomy and archaeology having spoken their 
word, if a glance be now cast at chapter i, verse 
28, of the Book of Genesis, it will be seen that, 
for a long series of centuries, civilized man has 



THE HUMAN BODY. 2J 

entertained the belief that the object of his exist- 
ence is to multiply his species. The first com- 
mand to man was " Increase and multiply and 
fill the earth." That was to be the one function 
of man. The other commands, to subdue the 
earth and rule over all living- creatures, are sub- 
ordinate to the first command, to the one func- 
tion. Man was to subdue the earth to the end 
of fulfilling that first command, and he was to 
rule over all living creatures and make such use 
of them as might be subservient to that first 
command. The general disobedience of that 
command would entail disease, death and the 
speedy extinction of the species. 

All organic nature is busy with the multiplica- 
tion of species. In the lowest forms of animal 
and vegetable life this multiplication continues 
until by some accident the process is interrupted. 
Such an interruption is one of the checks to the 
inordinate increase of the species; but when the 
process ceases, extinction is the inevitable out- 
come. 

Man alone is prone to violate the great law of 
creation which impels organized beings to repro- 
duce their kind. In these days there are too 
many unfortunates who, desirous to sin without 
conceiving, adopt the most injurious means to 
effect their purpose. Among these may be men- 



28 DEFINITION AND OBJECTS OF MEDICINE. 

tioned the iniquity of Onan, so common among 
the higher classes, so demoralising and so hurt- 
ful to both the male and female. 

Most persons are conscious that many of their 
diseases are caused by their own vices and ex- 
cesses, the consequences of which are certain to 
assail and perhaps to destroy them. Often 
blinded however by their passions, or heedless of 
nature's inexorable laws they fail to perceive the 
cause of a particular malady until it is almost if 
not altogether too late for its removal. Then 
perhaps they have reluctant recourse to the 
physician. 

DEFINITION AND OBJECTS OF MEDICINE. 

It often happens that certain patients long 
hesitate to consult the true physician, who pre- 
scribes for disease and not for symptoms, be- 
cause of their vague notions of the character and 
scope of rational medicine — so much derided by 
cynics and charlatans — and of their idea that the 
practiser of medicine gropes in the dark in his 
search for the nature of diseases and for the 
means of their cure, and that his diagnosis is con- 
jectural while his treatment is empirical. To a 
man of this class the title of Doctor in medicine 
is a misnomer, because the " Doctors " whom he 



DEFINITION AND OBJECTS OF MEDICINE. 29 

knows are neither learned nor wise. He had 
never been able to make the distinction between 
the ignorant pretender and the conscientious and 
well qualified physician. He is at length brought 
face to face with a Doctor whose mental quali- 
ties give him a right to the title. After a short 
conference he propounds the old question so 
often asked by the laity, " what is meant by 
medicine, and can it be ranked as a science " ? 
The answer to this question involves a definition 
of a science and of an art. If knowledge, 
acquired by study, experiment, and observation, 
methodically arranged to serve as a basis upon 
which are established general and particular 
principles for guidance in the practice of an art, 
be accepted as one of the definitions of a science, 
and if an art can be defined as skill acquired in 
the use of means for the accomplishment of an 
end, then medicine is entitled to be ranked as a 
science and an art. These definitions may be 
thus condensed ; science is to know^and art is to 
do. This is the answer to the second part of the 
question. The first part will be answered by a 
definition of medicine and by a concise statement 
of its aims and of the methods employed in its 
study. 

Medicine,* as related to man, may be defined 

* Medicine, from mederi, to heal. 



30 DEFINITION AND OBJECTS OF MEDICINE. 

as the science of man in his abnormal states, and 
the art of curing or of alleviating disease. 

Medicine presupposes the science of man in 
his normal state, and implies the arts of preserv- 
ing health, of preventing disease, and of prolong- 
ing life. 

Medicine and its fundamental science and 
associated arts lay under contribution botany, 
zoology, mineralogy, chemistry, pharmacology, 
physics, mathematics, and mechanics ; assist in 
the execution of the law of the land, particularly 
in the special department known as Medical 
Jurisprudence ; aid the State in the prevention 
of disease, through the department of State 
Medicine ; and have their influence upon the 
morals of the people. The system of medical 
morals written by the Father of scientific medi- 
cine more than two thousand years ago, is so 
sound in its broad principles as to have required 
no changes except in a few details, and the addi- 
tions that have been made thereto only serve to 
enforce these principles. The best modern ethical 
essays are founded upon the Hippocratic oath 
which was itself erected upon the imperishable 
foundation of reason, truth, justice, and bene- 
ficence. There can be only one medicine, the 
medicine which, together with its fundamental 
science and associated arts, is ever seeking the 



CLASSIFICATION OF MEDICINE. 3 1 

truth, and whose objects are to prevent, heal, or 
alleviate disease, to preserve health, and to pro- 
long life. 

True medicine, founded as it is upon biology, 
is not fettered by dogmata and is therefore al- 
ways advancing. The student of medicine must 
understand the laws of life, and be acquainted 
with the science of man in his normal condition, 
and very particularly with the functions of the 
apparatuses of his body. (Until then he is unfit 
to study, and still more unfit to cope with dis- 
ease. This leads to what is believed to be a 
proper classification of medicine. 

CLASSIFICATION OF MEDICINE. 

Medicine comprises : (A,) the science ; and 
(B,) the art of medicine. 

A. THE SCIENCE of medicine and its funda- 
mental science of man in a normal state consist : 
(I,) of anthropophysiography, or the description 
of man in a state of health ; and (II,) of anthro- 
ponosography, or the description of man in a 
state of disease. 

I. Anthropophysiography comprises all the 
branches of anatomy and is the same as human 
biology. 

Anatomy is divided into: (i,) transcendental 



32 CLASSIFICATION OF MEDICINE. 

anatomy ; (2,) homological anatomy ; (3,) phys- 
iognomical anatomy; (4,) embryology; (5,) de- 
scriptive anatomy ; (6,) comparative anatomy ; 
(7,) topographical anatomy ; (8,) histology ; (9,) 
stoechiology ; (10,) human physiology ; and (11,) 
comparative physiology.* 

/. Transcendental anatomy is the study : (1,) of 
the general design of the body ; and (2,) of the 
particular design of the organs. 

2. Homological anatomy is the study of the cor- 
relations of the several parts of the body — (1,) of 
the organs and their parts ; (2,) of the tissues ; 
and (3,) of the apparatuses of the body. 

j. Physiognomical anatomy is the study of ex- 
pressions depicted upon the exterior of the body, 
more particularly upon the face, such as expres- 
sions of joy, despondency, mental anxiety, pain, 
fear, anger, etc. ; and is also the study of those 
expressions induced by disease. f 



* These branches of anatomy are not ordinarily studied in 
the order in which they appear above, but the arrangement 
adopted is in correspondence with the general plan of this 
work. 

t The facies of disease were very long ago carefully studied. 
Hippocrates described so graphically the expression often in- 
duced by the exhaustion incidental to certain chronic and 
acute diseases, and by long fasting, that this expression bears 



CLASSIFICATION OF MEDICINE. 33 

4. Embryology is the study : (1,) of the fecund- 
ation of the ovum ; (2,) of the growth of the 
embryo ; and (3,) of the development of the 
organs. 

5. Descriptive anatomy is the study : (1,) of the 
general configuration of the body and of the 
particular configuration of its several parts ; (2,) 
of the gross appearances of the organs ; (3,) of 
the construction of the organs ; (4,) of the form, 
size, color, consistency and weight of the organs ; 
and (5,) of the composition of the apparatuses. 

6. Comparative anatomy is the study and com- 
parison of the body and organs of man with 
those of the lower animals. Its object is to ascer- 
tain the nature of the modifications of structure 
adapted to the needs of different animals. 

7. Topographical anatomy is the study of the 
situations and relations of the several parts and 
organs of the body. 

8. Histology is the study: (1,) of the minute 
structure of the tissues ; and (2,) of the minute 
structure of the organs. 



the name of fades Hippocratica. There are too the facies of 
cancer, of tuberculosis, of cholera, of hysteria, of epilepsy, etc. 
The facial expressions varying also according to the seat of 
particular diseases. 



34 CLASSIFICATION OF MEDICINE. 

9. StoecJiiology * is the study of the chemical 
elements of the gases, fluids, and solids of the 
bod}'. 

10. Human physiology is the study : (1,) of the 
uses of the organs ; and (2,) of the functions of 
the apparatuses of the body of man. 

11. Comparative physiology is the study and 
comparison of the uses of the organs and of the 
functions of the apparatuses of all organized 
beings. 

II. Antroponosography, which should be 
based upon all the branches of anatomy, consists 
of the two divisions: (1,) teratology; and (2,) 
pathology. 

/. Teratology is the study of the congenital 
anomalies of the whole or of parts of the body. 

2. Fathology is the study: (1,) of general 
diseases ; (2,) of diseases of particular organs ; 
(3,) of diseases consequent upon parasitic inva- 
sion of the human organism ; (4,) of the conse- 
quences of the introduction of foreign substances 
into the body ; (5,) of the effects of injuries ; (6,) 
of the consequences of the ingestion of poisons ; 
and (7,) of functional disorders of the appara- 
tuses. 



* Stoechiology— from droixeiov, an element — is ordinarily 
taught under the names of physiological chemistry and organic 
chemistry. 



CLASSIFICATION OF MEDICINE. 35 

The means employed in the study of disease 
consist in making proper use ; (i,) of aetiology; 
(2,) of symptomatology ; (3,) of semeiology ; (4,) 
of pathoanatomy ; (5,) of pathohistology ; (6,) of 
nosonomy ; (7,) of nosotaxy ; (8,) of diagnosis ; 
and (9,) of prognosis. 

B. THE ART of medicine and its associated 
arts consist : (1,) of hygiene, or the art of pre- 
serving health ; (2,) of prophylaxy, or the art of 
preventing disease ; (3,) of therapy, or the art of 
curing or of alleviating disease ; and (4,) of 
biothalmy, or the art of prolonging life. 

I. Hygiene,* or the art of preserving health — 
The preservation of health is generally effected 
by the strict observance of the rules which relate 
to the maintenance, in their normal state, of the 
functions of the body and which are directed 
principally: (1,) to alimentation; (2,) to exer- 
cise; (3,) to clothing; (4,) to sleep ; (5,) to ablu- 
tion ; (6,) to residence ; (7,) to ventilation ; (8,) 
to light ; (9,) to temperature ; etc. 

II. Prophylaxy,^ or the art of preventing dis- 
ease. — Disease may be prevented : (1,) by avoid- 
ance of contagion ; (2,) by abstention from ex- 
cesses ; (3,) by the strict observance of the rules 

* Hygiene, from vyieid, health. 

t Prophylaxy, from itpo, beforehand, and (pvXdrreiv, to 
guard. 



36 CLASSIFICATION OF MEDICINE. 

of hygiene ; (4,) by the use of medicinal sub- 
stances having propylactic properties ; (5,) by 
the selection of a suitable climate ; (6,) by disin- 
fection ; (7,) by proper house drainage ; (8,) by 
the isolation of cases of contagions disease. 

III. Therapy, * or the art of curing or of al- 
leviating disease. — It should be borne in mind 
that many diseases are cured by unassisted na- 
ture, nevertheless they require the closest ob- 
servation of the medical attendant. Meddle- 
some physic in such circumstances is often pro- 
ductive of much evil. Here then is a field for 
the exercise of good judgment on the part of the 
wise physician who knows when to apply and 
when to abstain from applying remedies. Here 
too is the opportunity for the charlatan to make 
the most of his spurious wares, and to boast of 
" great cures " which he never effected. How- 
ever, in ordinary circumstances of disease, na- 
ture needs assistance and this assistance should 
be intelligent, prompt, and efficient. Such assist- 
ance may be directed : (1,) to a general disease ; 
(2,) to a special disease of a particular organ ; 
(3,) to an injury ; etc. The internal use of med- 
icaments, external applications, mechanical ap- 
pliances, or the surgeon's ministrations, may be 



* Therapy, from 0epa7t£veiv, to cure. 



CLASSIFICATION OF MEDICINE. 37 

needed. From these resources, for the cure or 
alleviation of disease, it is the office of the 
physician to select that which is suited to in- 
dividual cases. 

IV. BlOTHALMY,* or the art of prolonging life. 
— Man's life may be prolonged beyond its ordi- 
nary duration, if he be free from disease, (i,) by 
great sobriety and moderation in all his acts ; (2,) 
by the close observance of the rules of hygiene ; 
(3,) by avoidance of exposure during inclement 
weather ; and (4,) by his leading a serene exist- 
ence, free from the cares of ordinary life, but 
with pleasant pursuits, f When man is affected 
with incurable disease, his life may be prolonged : 



* Biothalmy, from BioSaXjuioS, long-lived. Macrobiosis 
is also used to express the idea of longevity. 

t On this important subject of the prolongation of man's 
life, the reader may, with advantage, consult " The Code of 
Health and Longevity," by Sir John Sinclair, Edinburgh, 1807. 
This very interesting and valuable compilation, in four octavo 
volumes, contains : rules for preserving health and promoting 
longevity ; regulations for the health of the community ; an 
account of the doctrines of Hippocrates concerning health and 
longevity ; also accounts of Galen ; of the minor Greek 
authors ; and of the Arabian and Jewish authors who have 
written on the subject of health ; and of Cicero and Seneca 
on old age and the shortness of life. It also contains the 
" Regimen Sa?iitatls Sa/emi," with Doctor Holland's transla- 
tion thereof ; an account of Lewis Cornaro, a Venitian gentle- 



38 CLASSIFICATION OF MEDICINE. 

(i,) by a proper dietary ; (2,) by suitable medica- 
ments ; (3,) by the maintenance of certain func- 
tions, as far as practicable, in their normal state ; 
(4,) by rest or exercise as needed, and attention to 
the conditions of the physical surroundings ; (5,} 
by mechanical appliances; and (6,) by a surgical 
operation, if such be required. 

man who lived a " sober life " and died aged upward of one 
hundred years , of the weighing chair of Sanctorius and of his 
Medicina Statica ; and an account of British authors who 
have written upon health and longevity, from Friar Bacon 
who died in the year 1292, to Doctor Waterhouse in 1805. 
Among the many accounts of centenarians given in this work, 
are those of John Rovin in his one hundred and seventy- 
second (172) year, and of his wife Sarah in her one hundred 
and sixty-fourth (164) year, and of Petratsch Zortan in the 
one hundred and eighty-fifth (185) year of his age, with en- 
gravings of their portraits which had belonged to the Percys, 
Earl of Northumberland. 

An essay by J. P. M. Flourens, bearing the following title, 
may also be profitably consulted : " De la longevz'te humaine 
et de la quantite de vie sur le globe." Paris, 1856. 

A very interesting paper on " the habits and family history 
of centenarians " by Professor Humphry appeared in the 
" Popular Science Monthly " for March 1887. This paper had 
formed a part of a report on the subject by Professor Hum- 
phry to the British Medical Association. It contains an 
analysis of the table of centenarians, by A. Francis, M. R. 
C. S., of Kings College, Cambridge, which is well worthy of 
careful perusal. 



39 

MEDICINE AND SURGERY. 

Medicine has been separated into two depart- 
ments : (i,) Medicine proper, or, as the French 
still call it, internal pathology ; and (2,) Surgery, 
or external pathology.* Neither designation is 



* For many centuries medicine was in the hands of the 
priesthood. In Egypt, for instance, none but the priests were 
permitttd to minister to the sick ; among the early Israelites, 
the Prophets, Priests and Levites were the only physicians ; 
and the Priests of Apollo and of Esculapius were, for a long 
time, the only medical advisers of the Greek people. This 
most ancient custom, of combining the offices of physician 
and priest, was adopted by the Christian clergy and prevailed^ 
with few interruptions, until the middle of the eighteenth 
century. 

The school of Salernum owed its celebrity, from the eighth 
to the twelveth century, to the many learned members of the 
clergy who there taught or were taught medicine. Among 
these illustrious men may be mentioned ; Theodore, Arch- 
bishop of Canterbury ; Wigart, Bishop of Hildesheim ; 
Cuthbert, the English monk ; the monk Campo ; Hughes, 
Abbot of Saint Denis ; John of Ravenna ; and Gerbert, after- 
wards Pope Sylvester II. They had all learned the medicine 
of the Arabs. 

During the eleventh century the Benedictine monks of 
Monte Cassino greatly distinguished themselves at the Saler- 
num school, and Didier, the Abbot of Monte Cassino, who be- 
came Pope Victor III, was one of the teachers in that 
renowned school. 

In the twelveth century priests were forbidden to practise 



40 MEDICINE AND SURGERY. 

rational, for " medicine proper " has to deal as 
much with external as with internal diseases, and 
surgery has as much to do with internal as with 
external diseases. The physician uses his hands 
in diagnosis and in ministering to the sufferings 
of his patients as much as does the surgeon. The 
word " surgery," meaning simply the art of 
healing by the use of the hands, does not neces- 
sarily imply how the hands shall be used. It 
does not mean that the hand must needs contain 
a cautery or a knife any more than a blister or a 
poultice, or that the hands shall reduce a hernia 

surgery, that is to say to use the knife and shed human blood 
or to use the actual cautery, and even to study medicine. But 
during the crusades, and when leprosy was imported into 
Western Europe, the lepers' hospitals were attended entirely 
by monks. 

There came another prohibition, in the latter part of the 
thirteenth century, under the pontificate of Boniface VIII. 

The law of celibary imposed, in France, upon physicians, 
was abrogated, in 1452, through the influence of Cardinal 
d'Etouteville. This should have placed medicine entirely 
in the hands of the laity. It did not however ; for the 
clergy continued to practise medicine. 

The final decree prohibiting priests from practising medicine 
or surgery was promulgated in the middle of the eighteenth 
•century during the pontificate of Benedict XIV. (Diocesan 
decrees, Book XIII, chapter X.) 

Medicine and surgery were not made absolutely distinct 
branches until the fourteenth century. 



MEDICINE AND SURGERY. 41 

rather than percuss a chest or administer a po- 
tion. The term " medicine " was applied to the 
healing of wounds long before internal diseases 
were understood. 

The term chirurgery, relating to manual opera- 
tions, was, according to Celsus, not used until 
the time of Herophilus (307 B. C). A few cen- 
turies ago the word surgeon was employed to 
designate the " barber-surgeon " in contradistinc- 
tion from the educated healer who was styled 
4i Master in chirurgery." 

In France, as early as the beginning of the 
fourteenth century, no barber-surgeon was per- 
mitted to exercise his calling until he had been 
examined by certain Masters in chirurgery.* 

It would seem preferable to use the word med- 
icine as a generic term and to arrange the science 
and art of medicine into certain departments in 
accordance with the several apparatuses of the 
body such, for instance, as relate ; (I,) to affec- 
tions of the cephalo-rhachidian apparatus and of 
its subsidiary apparatuses ; (II,) to affections of 



* '* Rule in favor of the Masters in chirurgery of the month 
•of August 1301," contained in Girodat's presentation of the 
■case of the surgeons of Paris under the title of '• Recherches 
Critiques et Hisioriques sur I'Origine, sur les Divers Etats, 
£t sur les Progres de la Chirurgie en Fratice," Paris 1744, 
P- 435- 



42 THE PHYSICIAN. 

the nutritive apparatus and of its subsidiary ap- 
paratuses ; (III,) to affections of the motory 
apparatus ; (IV,) to affections of the cutaneous 
apparatus ; and (V,) to affections of the generative 
apparatus which united to the urinary apparatus 
constitutes the uro-genital apparatus. 

General affections, involving several appara- 
tuses, should also be arranged into proper 
groups. 

THE PHYSICIAN. 

The ancient Greeks called the physician 
idrpoty the healer. The ideal physician should 
however be more than a mere healer of wounds 
or a prescriber of pills and potions. — Handicraft 
and shrewdness are his lowest attributes. — He 
should, in a broad sense ol the word, be a philan- 
thropist (implying not only a lover but a knower 
of man), and a close, thoughtful, observer of the 
nature of the human apparatuses, the disorders 
of whose functions he has to interpret. He 
should investigate questions relating to the 
structural and other characters of diseases. He 
should devise means for the cure of diseases, and 
formulate rules for their prevention. He should 
be both iatrosophista and iatrotechna, learned in 
the science and skilled in the art of medicine. 



43 

DEFINITION AND GENESIS OF DISEASE. 

In this connection it will be proper to answer 
:he commonly asked question ; " What is meant 

3y disease ? " 

Disease is a deviation from the normal state 
}f the whole or of any part of the body. 

The term disease* was long ago introduced 
nto medical language to express the idea of 
Dodily uneasiness or distress such as may be 
caused by an injury ; by an interruption, or a 
iisturbance of vital functions ; or by an alteration 
n the structure of an organ or of several organs 
)f an apparatus or of all the apparatuses of the 
)ody. Hence it is that diseases have been classed 
nto functional and organic diseases, f But dis- 
;ase of an organ always disorders, in a greater 

* The etymology of the word disease though having little 
cientific value, is not without interest. This word is derived 
rom dis, without, and ease, through the old French desaise, 
ack of ease, uneasiness, distress. 

t In a written communication on this subject, Professor 
Meredith Clymer of New York uses the following language : 
'There can be no change in the accustomed expression of an 
.ctivity — either by increase, diminution or perversion — with- 
•ut coincident change in the plasmode. Hence strictly there 
an be no such thing as a functional as distinguished from a 
tructural disease. Disease is always material, whether 
ecognisable as such or not." 



44 DEFINITION AND GENESIS OF DISEASE. 

or less degree, the function of the apparatus to 
which it belongs, and sometimes disorders the 
functions of several apparatuses. Therefore such 
a classification is faulty and misleading. 

The affections of the human body may be : 
(i.) Congenital, resulting from vices of the pri- 
mary conformation ; 
(2.) Hereditary, transmitted by progenitors ; 
(3.) Primary, arising from more or less well 

known causes ; 
(4.) Secondary, consequent upon preexisting dis- 
ease — in this case the word pathengenetic * 
expresses briefly the idea of a disease spring- 
ing from another disease ; 
(5.) Traumatic, resulting from injuries ; or 
(6.) May be the outcome of errors of diet, of the 
effects of climate, of parasitic invasion, and 
of gaseous, mineral, vegetable, or animal 
poisons, including ptomaines and leucomaines. 
Although these affections number many spe- 
cies, the morbid states and morbific processes 
from which these species originate are compara- 
tively few and are comprised under the follow- 
ing captions : (1,) alterations in the composition 
of the blood; (2,) disturbances in the circulatory 



* The word pathengenetic was lately coined by Dr. Alfred 
L. Carroll. 



MORBID STATES & MORBIFIC PROCESSES. 45 

apparatus ; (3,) pathengenetic alterations of struc- 
ture ; (4,) retrograde metamorphoses; (5,) new 
growths; (6,) granulation-growths; (7,) cysts; 
(8,) stones; (9,) injuries; (10,) monsters; (n,) 
extraneous bodies; (12,) parasites ; (13,) poisons ; 
(14,) functional disorders. 

SYNOPSIS OF THE MORBID STATES AND MORBIFIC 

PROCESSES OF THE BODY, BEING 

A SUGGESTION OF A GROUND WORK FOR THE 

CLASSIFICATION OF DISEASES. 

I. Alterationes in quantitate, in qualitate, et in 
compositione sanguinis, (Alterations in the 

quantity, quality, and composition of 
the blood). 

1. Hyperaemia, (Superabundance of blood). 

2. Hypoaemia, (Insufficiency of blood). 

3. Hyperhydraemia, (Increase of blood- water). 

4. Hypohydraemia, (Decrease of blood-water). 

5. Hyperinosaemia, (Increase of blood-fibrin). 

6. Hypoinosaemia, (Decrease of blood-fibrin). 

7. Hyperleucontaemia,* (Increase of blood-albumen). 

8. Hypoleucontaemia, (Decrease of blood-albumen). 

9. Hyperalonaemia, (Increase of blood-salts). 
10. Hypoalonaemia, (Decrease of blood-salts.) 

II. Hyperchromataemia, (Increase of blood-color). 



* Xsvhov, the white of an egg — albumen. 



46 MORBID STATES & MORBIFIC PROCESSES. 

12. Hypochromataemia, (Decrease of blood-color). 

13. Hyperleucocythaemia, (Increase of white blood- 

cells). 

14. Hypoleucocythaemia, (Decrease of white blood- 

cells). 

15. Hypererythrocythaemia, (Increase of red blood- 

cells). 

16. Hypoerythrocythaemia, (Decrease of red blood- 

cells). 

17. Hyperlipaemia, (Increase of blood-fat). 

18. Hypolipaemia, (Decrease of blood-fat). 

19. Hyperphysaemia, (Increase of blood-gas). 

20. Hypophysaemia, (Decrease of blood-gas). 

21. Hyperglycaemia, (Increase of blood-sugar). 

22. Hypoglycaemia, (Decrease of blood-sugar). 

23. Acetonaemia, (Acetone in the blood). 

24. Ammoniaemia, (Ammonia in the blood). 

25. Hyperuraemia, (Increase of blood-urea). 

26. Hypouraemia, (Decrease of blood-urea). 

27. Hyperuricaemia, (Increase of blood-uric acid). 

28. Hypouricaemia, (Decrease of blood-uric acid). 

29. Cholaemia, (Bile in the blood). 

30. Hypercholesteraemia, (Increase of blood-choles- 

terin). 

31. Hypocholesteraemia, (Decrease of blood-choles- 

terin). 

32. Melanaemia, (Black pigment in the blood). 

33. Septicaemia, (Putrid infection of the blood). 

34. Pyosapraemia, (Putrid-pus infection of the blood). 



MORBID STATES & MORBIFIC PROCESSES. 5 1 

XIII. Venena, (Poisons,) including all kinds of 

gaseous, mineral, vegetable, and animal 

poisons. 

XIV. Vitia functionum, (Disorders of the 
functions. 

i. Perversio, (Perversion). 

2. Deficiens, (Deficiency). 

3. Immoderatio, (Excess). 

4. Diminutio, (Diminution). 

5. Suspensio, (Suspension). 

6. Abolitio, (Abolition). 



COMMENTS ON SOME OF THE TERMS USED 

IN THE SYNOPSIS OF MORBID STATES 

AND MORBIFIC PROCESSES. 

The names given to the morbid states and 
morbific processes of the body should be changed 
whenever the true nature of these states and pro- 
cesses is discovered. Many of the names only 
convey an erroneous idea of the condition which 
they are intended to express. 

The term inflammation, for instance, is used 
under protest until a better term shall be agreed 



52 TERMS USED IN THE SYNOPSIS OF 

upon by the profession. The coinage of this 
word is based upon symptoms and not upon 
morbid properties. When the exact pathic con- 
dition of this so called inflammatory process is 
clearly defined, the proper name will be found, 
and when this is found, words will probably be 
coined in place of those ending in itis to denote 
inflammation of particular parts of the body. 

Auxesis* is placed under the caption alterations 
of structure because increase in bulk of an organ 
may and does occur independently of what is 
called inflammation. This word is substituted 
for hypertrophy which ordinarily is improperly 
used in the sense of augmentation. Hypertrophy 
neither means nor does it even imply enlarge- 
ment. It signifies over-nourishment, the opposite 
of no nourishment or atrophy. When the body 
is over-fed, the organs do not of necessity en- 
large, but much of the surplus nourishment is de- 
posited, in the form of fat, under the skin, in the 
mesentery, and around the kidneys ; this is an 
example of true hypertrophy. The organs of 
the human body receive nourishment to the ex- 



* Auxesis, from avtydiS, increase, augmentation enlarge- 
ment. 



MORBID STATES & MORBIFIC PROCESSES. 53 

tent of their requirements, neither more nor less 
whatever may be their condition. When, from 
disease, an organ slowly increases in size and 
afterwards does not tend to decrease, the calibre 
and length of its nutrient arteries are often 
found to be increased and the thickness of the 
walls of these vessels is also proportinately aug- 
mented. This condition of the blood vessels is 
not ordinarily called hypertrophy. It is assuredly 
a great inconsistency to apply the term hyper- 
trophy to an enlarged organ and not to its en- 
larged arteries. The careful study of the morbid 
anatomy of enlarged organs shows that the 
auxesis has a cause entirely foreign to over- 
nourishment. The disturbing element may or 
may not be carried to it by the blood, and when 
it is so carried, the enlargement is due to this dis- 
turbing element and not to the quantity of blood 
which is only proportionate to the demand of the 
organ for its adequate nutrition. A liver enor- 
mously enlarged from cancerous disease is not 
generally called hypertrophied, and yet it may 
receive one third more blood than when it was in 
a normal condition. A large fatty liver is called 
a fatty and not a hypertrophied liver. The well 
developed muscles of the athlete are not over- 
nourished. If they were, he would probably be 
unfit to perform his feats of strength and agility. 



54 TERMS USED IN THE SYNOPSIS OF 

The enlarged heart is not over-nourished ; it is 
as likely to be inadequately fed. 

The only other instance of hypertrophy is that 
which occurs in the beginning of certain varieties 
of local inflammation when, for a short period, 
the parts are over-fed owing to an undue activity 
in the circulation. This may soon be followed by 
stasis of blood in the capillaries. During the 
static period there is hypotrophy — diminished 
nutrition, under-feeding — , and if the stasis per- 
sist, nutrition ceases. Here then is true atrophy. 
The part that is no longer nourished dies. This 
is what is commonly called mortification which 
is regarded as an unfavorable termination of the 
inflammatory process. Marasmus, and the ema- 
ciation which occurs in phthisis pulmonalis or in 
the course of febrile disorders, such as typhui," 
and typhoid fevers ; in the course of cancerous •* 
affections ; in chronic pyelo-nephritis ; and in 
saccharine diabetes, exemplify hypotrophy. An 
organ which has decreased in size may be called 
meiomous.* , 

Hypertrophy and atrophy are correctly coined, 
and good words in their proper places. It 
only their misuse that is here criticised. 

The words hypertrophy and atrophy , f i 

atic 

* Meiomous, from /^EiGOfxa y a decrease. 



MORBID STATES & MORBIFIC PROCESSES. 55 

kidneys which are employed in the English no- 
menclature of diseases in the year 1869 are re- 
jected in the revision of 1885. The hypertrophy 
referred to was presumably applied in 1869 to 
the form of disease now called in the revised 
edition of 1885 "large white kidney of nephri- 
tis " which is a condition of auxesis or enlarge- 
ment. In like manner atrophy was employed in 
1869, but to express the opposite condition now 
known, and classified in the revised edition, as 
contracted kidney, which is a decreased or mei- 
omous kidney, a retrograde metamorphosis. It 
seems clear in both these instances that the word 
hypertrophy and atrophy, used in 1869 in the case 
of the kidney, failed to convey an adequate idea, 
in the minds of the revisers, of the pathic condi- 
tions in question, or else, in the revision of 1885, 
they would not have been abandoned. 

If therefore this interpretation of the omission 
be correct, why should it not be applied to all 
cases where the word hyphertrophy is used in 
the sense of increase in bulk, and atrophy in the 
sense of diminution ? 

Auxetic affections may be echmatic as in cer- 
tain types of enlargement of the prostrate, or 
may not be echmatic as in uniform enlargement 
of the prostate which does not impede the flow 



$6 TERMS USED IN THE SYNOPSIS OF 

of urine. Some auxetic affections are neoplastic, 
others are pathengenetic. 

The words hypertrophy and atrophy will not 
be employed in this work except when in their 
true meaning, they are absolutely required. 

Stenosis* is generally the outcome of inflamma- 
tory action. Stenotic affections are pathic con- 
ditions of the excretory ducts and of hollow 
viscera by which these ducts are narrowed and 
the viscera lessened in capacity, as in the case of 
stenosis or stricture of the urethra or in the case 
of a permanently contracted bladder with mark- 
edly diminished capacity. A stenotic affection 
may or may not be echmatic. It is often echmatic 
in stricture of the urethra, but not in stenosis of 
the bladder. Stenotic affections are sometimes 
congenital, sometimes traumatic, but most fre- 
quently they are pathengenetic,^ that is to say 
are the sequelae, the offspring of, or are engen- 
dered by a preexisting morbid condition, as for 
instance, the strictures which result from ureth- 
ritis, or the stenosis of the bladder springing 
from inflammation of that viscus. 



* Stenosis, from 6tev6go, to make narrow, to contract. 
t Pathengenetic, from xaQoS, a disease, and Eyyevrji, 
sprung from. (Carroll.) 



MORBID STATES & MORBIFIC PROCESSES. $7 

Ectasis * is a condition of expansion or dilata- 
tion of certain serous cavities, hollow viscera, 
excretory ducts, and lymphatic and blood vessels. 
Stenotic affections are pathengenetic, and due to 
inflammatory action, or to obstruction from dis- 
ease or from the lodgment of a foreign body. 
Morbid dilation of the bladder, general or local, 
is an ectatic affection. A so called hydrocele of 
the tunica vaginalis gives rise to ectasis of the 
tunica vaginalis. 

Echmasis f may result from inflammation, from 
a neoplasm, or from the lodgment of a foreign 
body. Echmasis is here used in preference to 
epischesis of which Vogel makes a class and 
Cullen an order. Epischesis, from e-rcex^y, to hold 
up, to check, to restrain, is defined as a suppres- 
sion of excretions. Echmasis defines more 
exactly the character and the cause of the sup- 
pression of the excretion, as in the case of reten- 
tion of urine in the bladder, which generally has 
for its cause a material obstruction in the urinary 
passage, such as stricture of the urethra or en- 
largement of the prostrate. Echmatic affections 
may therefore be also stenotic or auxetic, and 



* Ectasis, from ex, out, and reiveiv, to stretch, expand, 
or extend, 
t Echmasis, from e'xM<x, obstruction, obstacle, hinderance. 



58 TERMS USED IN THE SYNOPSIS. 

they may be pathengenetic, that is to say may 
spring from or be engendered by a preexisting 
pathic condition. 

Blastoma * should be substituted for granuloma 
which is a hybrid word meaning, according to 
Dunglison, " a morbid product formed by parti- 
tion and multiplication of the connective tissue 
cells into groups of others resembling lymph 
cells, lying in an intercellular substance, with a 
tendency to fatty degeneration ; as elephantiasis 
{Graecorum), lupus, etc." The same author de- 
fines a granule as " a small grain, a compact par- 
ticle, a cytoblast." The French name for granu- 
lation is bourgeon char?iu, fleshy bud. Blastoma 
seems to express the meaning intended to be con- 
veyed by granuloma, and something more, for 
the blastomata are now regarded, by many his- 
tologists, as affections caused by the presence of 
microorganisms, and on this account also the 
word blastoma is preferable to granuloma which, 
besides being an ill-formed word, fails to convey 
the idea of a germ disease. 

The term disorder^ is applied to functional af- 
fections, e. g., disorder of a function, or func- 
tional disorder. An organ is said to be diseased, 



* Blastoma, from ft'ka6ro%, shoot, bud, germ, and aojua. 
t Disorder, from dis without, and order. 



PROPER ANATOMICAL TERMS. 59 

but a function disordered. Functional disorders 
are caused by disease of one or of more than one 
organ of an apparatus. It is often difficult and 
sometimes impossible to ascertain which of the 
organs of an apparatus is so diseased as to dis- 
order the function of that apparatus. 

Of the six genera of functional disorders enu- 
merated in the synopsis of morbid states and 
morbific processes, only four were formerly 
recognised. It has seemed proper to add de- 
ficiency (2), which is exemplified by the lessening 
of urea in the urine, and suspension (5), which is 
exemplified by anuria, and also by retention of 
urine. 

THE VALUE AND SIGNIFICANCE OF PROPER 
ANATOMICAL TERMS IN CLASSIFICATION. 

Certain explanatory comments are now due re- 
specting this proposal for the establishment of a 
stable basis for the nomenclature and classifica- 
tion of diseases in general and of affections of the 
uro-genital apparatus of the male in particular. 

In accordance with the definition given of the 
word disease, parasitic affections ; congenital ab- 
normities ; the lodgment, in the body, of extrane- 
ous substances or of poisons ; and injuries ; may, 
with propriety, be classed among the diseases of 



60 PROPER ANATOMICAL TERMS 

man, for they, also, interrupt or they disturb 
vital functions. At the same time the word 
affection may be used as an equivalent term 
to disease whenever it is found convenient ; 
for, although an affection does not always imply 
the existence of an organic morbid condition with 
structural change, all diseases are affections. For 
instance man may be affected with a congenital 
malformation, or an injury, as well as with a 
disease in which there is alteration of structure 
or impairment of function. 

Apparatus is used instead of system for the 
reasons herein given. 

English speaking authors of high reputation 
have, for a long time past, made use of the 
phrase genito-urinary system, although the word 
system, in this sense, is so obviously inappropri- 
ate. A critical examination of the subject will 
not fail to convince the inquirer that system, in 
this particular sense has been misapplied if he 
take the pains to consult the standard medical 
dictionaries. . 

The word system* when used in the anatomical 
sense, signifies an assemblage of organs composed 
of the same tissues and intended for similar uses, 
as for instance the nervous system (system of 

* System, from SvSr??jxa, from SvriSrr/jLii to place together. 



IN CLASSIFICATION. 6l 

nerves), the arterial system, the venous system, 
the lymphatic system, the muscular system, the 
osseous system, the ligamentous or desmic sys- 
tem, etc. Systems have general uses, but per- 
form no functions. They are all contained in 
apparatuses, to which they yield service. 

In the nomenclature of diseases prepared by 
the joint committee appointed by the Royal Col- 
lege of Physicians of London (1869), system is 
throughout used instead of apparatus with the 
exception of the phrase " lacrymal apparatus." 
The use of the word apparatus in this isolated 
case would seem to be an inconsistency. The 
term apparatus being however accepted as the 
designation of the group of organs by which the 
tears are secreted and conveyed into the nasal 
cavity, it is evident that the groups of organs 
which perform the functions of sight, hearing, 
smell, taste, respiration, digestion, urination, 
generation, etc., should be regarded as so many 
apparatuses. 

In the first decennial revision (1885) of this 
same nomenclature, the word system continues 
to be used for apparatus, except as before, in the 
case of the lacrymal apparatus. But in the cap- 
tion which preceeds, the revisers make use of the 
term apparatus in a singularly inappropriate 
sense, i. e. " Disorders of the muscular appara- 



62 PROPER ANATOMICAL TERMS 

tus " of the eye. The visual, like the other ap- 
paratuses of the bod) 7 , contains parts of several 
systems ; therefore muscular system of the eye 
should have been used instead of muscular ap- 
paratus, since there is not, in anatomy, any rec- 
ognition of a muscular apparatus. Again, in this 
same edition of the London nomenclature, ap- 
paratus is used where system should have been 
applied, e. g\, "Nervorum apparatus morbi" The 
nervous system }-ields service to the cephalo- 
rhachidian and other apparatuses, but there is no 
nervous apparatus. Another example is in the case 
of " Diseases of circulatory system,'" latinised into 
"Sanguinis apparatus morbi." The circulatory 
apparatus comprises a system of arterial, of 
venous, and of lymphatic vessels, with certain 
reservoirs, and a pump to carry on the circula- 
tion. Therefore there exists neither a blood ap- 
paratus nor a circulatory system, but properly a 
circulatory apparatus. Still another inconsis- 
tency may be noticed in the case of " Diseases of 
the respiratory system, " latinised into " Spiritus 
organorum morbi" and why not here apparatus 
instead of organs, since the next Latin caption is 
" concoctionis apparatus morbi" which is translated 
into " Diseases of the digestive system " ? 

These may perhaps be regarded as fair ex- 



IN CLASSIFICATION. 63. 

amples of the many defects which seriously mar 
the modern English system of nomenclature. 

An orgati* in anatomical parlance, is a part of 
the body designed to contribute its share to 
whatever may be necessary for the completion of 
a function. An organ may aid in the performance 
of two or more than two entirely different func- 
tions. For instance the urethra, while it trans- 
mits the urine is a urinary organ, and while it 
transmits the semen it is a genital organ ; and 
there is no lack of other equally good examples in 
human anatomy. Therefore an organ performs 
no function, being simply one of an assemblage 
of instruments constituting an apparatus, which 
alone can perform a function, that is to say bring 
it to its completion. f " In the organs of a system 
of organs there is analogy of structure, while in 
the organs of an apparatus there is analogy only 
of function." % 



* Organ, from opyavov, an instrument. 

t An organ, like a system, yields service to an apparatus in 
the performance of its function, or to two or more than two 
apparatuses. Hence it is rightly said that an organ has its 
uses, while an apparatus performs its o?ie function. 

\ Dung'.ison, Littre and Robin, and Dechambre, Duval and 
Lereboullet. 



64 PROPER ANATOMICAL TERMS 

An apparatus* of the human body is an as- 
semblage of organs which work toward the same 
end or, in other words, which concur in a common 
function, though they be of different nature. An 
apparatus then comprises organs of differing 
anatomical constitution. An apparatus may be 
composed of, or may contain, several other ap- 
paratuses. For instance, the primary human ap- 
paratus consists of five secondary apparatuses 
which contain sixteen subsidiary apparatuses. 

The secondary apparatuses of the body are : 
(I,) the cephalo-rhachidian apparatus, containing 
the subsidiary apparatuses,(i ,) of vision — including 
(2,) the lacrymal apparatus — , (3,) of audition, (4,) 
of olfaction, and (5,) of gustation ; (II,) the nutri- 
tive apparatus containing the subsidiary appara- 
tuses, (6,) of mastication, (7,) of deglutition, (8,) 
of digestion, (9,) of absorption, (10,) of circula- 
tion, (11,) of respiration, f — containing (12,) the 
apparatus of phonation — , (13,) of urination, and 
(14,) of defecation; (III,) the motory apparatus; 
(IV,) the cutaneous apparatus, containing (15,) 



* Apparatus, from the prefix ad, and parare, paratum, to 
prepare. 

t The respiratory apparatus contains, but is subsidiary to, 
the phonetic apparatus which is subsidiary to the cephalo- 
rhachidian apparatus. 



IN CLASSIFICATION. 6$ 

the apparatus of touch,* and (16,) the apparatus 
of transpiration ; f and (V,) the apparatus of 
generation. 

The secondary apparatus of generation and the 
subsidiary apparatus of urination bear such close 
anatomical relations to each other that, for clin- 
ical purposes, they should be united under the 
name of the uro-genital apparatus. 

Parts of several systems are included in an ap- 
paratus as, for instance, nerves, vessels, glands, 
muscles, bones, cartilages, ligaments, connective 
tissue, mucous membranes, etc. Each apparatus 
accomplishes only one function, while each organ 
of that apparatus may have several uses. There 
is no apparatus but performs a function, and 
there is no function without an apparatus (Robin), 
man himself being a grand primary apparatus 
destined to perform only one function.;): 



* The tactile apparatus is subsidiary to the cephalo-rhachi- 
dian apparatus. 

t The transpiratory apparatus is subsidiary to the nutritive 
apparatus. 

| Inasmuch as the views above expressed have been charac- 
terized as allied to positivism, it is proper that some notice be 
here taken of this assertion. The subject under consideration 
js man's body, not his soul ; his anatomy, not his psychology. 
Anatomy, in all its branches, teaches nothing contrary to be- 
lief in an Almighty God Creator of all things. A firm believer 



66 PROPER ANATOMICAL TERMS 

The primary apparatus man then, consists of 
an assemblage of secondary apparatuses ; a sec- 
ondary apparatus consists of an assemblage of 
subsidiary apparatuses ; and a subsidiary appara- 
tus consists of an assemblage of organs and ot 
parts of systems. 

A function * is the act accomplished, not by an 
organ or a system of organs, but by an appara- 
tus which, as already stated, consists of an as- 
semblage of differing organs. Therefore the use 
of the word function should be restricted to the 
act of an apparatus. 

If the following comparison be allowable, the 
human apparatus may be likened to a grand 
orchestra consisting of many differing musical in- 
struments and of men to perform thereon. The 
function of each performer and his instrument 
being music. In this case each instrument is- 
passive until it is played upon, when it becomes 

in God, who masters anatomy discovers therein nothing to- 
disturb his creed. Anatomy can deal with only what is finite 
in man ; but with the infinite part of man, that which is God- 
like, it can have nothing to do, and on this immortal part of 
man, it can have nothing to say worth hearing, nor is it ever 
likely to shake the faith that is once well implanted in any 
mind. 

* Function, ftmctio from fungi, functus, to act, to per- 
form. 



IN CLASSIFICATION. 6/ 

a secondary apparatus, and a collection of such 
secondary apparatuses constitutes the grand 
orchestra or primary apparatus whose function 
is Jiarmonions music. 

Doctor Meredith Clymer defines u a function 
as the sum of the automatic activities of the or- 
gans which go to make up an apparatus, and 
says ; an organ ' yields service to an apparatus/ 
but it can only do this by being put into act, and 
that act must be the result of an antonomous, in- 
hering property, a potentiality, set free by a lib- 
erating force. The product is an activity or func- 
tion. An organ can yield no service in a passive 
state. It must be in an active state, and it cannot 
do or be active without a transformation of po- 
tential into kinetic energy by the liberation of 
energy.* " 

Doctor Clymer is known to be a close reasoner 
and to be convincing by his sound arguments, 
therefore it is not easy to venture upon anything 
like opposition to the views he so lucidly puts 
forth ; nevertheless an attempt will be made to 
find therein a possible flaw. 

The "activities" of organs are unquestioned, 
but if each of these organs be isolated, its activ- 
\ty is insufficient to constitute a function in a 



* From a written communication. 



68 PROPER ANATOMICAL TERMS 

physiological point of view. The organ must 
have the concurrence of other organs, or the 
function cannot be completed, in other words, 
the function can be performed only by an as- 
semblage of organs of differing anatomical prop- 
erties. Each organ contributing its share of 
activity toward the elaboration and completion 
of the function. To this assemblage of differing 
organs, the name of apparatus has been given, 
and the apparatus performs the function which 
is the terminal act. 

The Doctor's definition of function is excellent 
and is in harmony with the views contained in 
this work, but does not precisely agree with 
what follows, for if the " automatic activities " 
of certain organs go to make up the function of 
an apparatus, which is it that performs the func- 
tion ? Is it each organ or every organ ? Is it 
not all the organs together, of the apparatus, 
rather than each organ separately? If each organ 
separately, then an assemblage of organs, consti- 
tuting an apparatus, would perform as many 
functions as there are in it organs. But the con- 
trary is known to be the case in physiology. For 
instance, the function digestion is " the sum of 
the automatic activities " of the organs which 
constitute the digestive apparatus. The function 
motion is " the sum of the automatic activities ' 



IN CLASSIFICATION. 69 

of the organs which constitute the motory ap- 
paratus, etc. 

Littre and Robin define the function of an ap- 
paratus (in anatomy) as the special act which 
each apparatus executes, and define the uses of 
organs, as the acts executed by each organ. One 
and the same organ having several uses, while 
an apparatus performs only one function. " One 
and the same muscle may aid in the flexion and 
rotation of a limb. The jaw is used in mastica- 
tion and in phonation, etc. The word use should 
not be confounded with the word function which 
has an entirely different signification."* 

The difficulty arising from the employment of 
these terms does not lie in the interpretation of 
the acts themselves, but in language, in the 
modes of denoting and of differentiating the 
several acts. It is to be hoped that a suitable 
word, other than use or function, will be found 
to express a corect idea of the activity of an 
organ. The word function however seems well 
adapted to denote the act of an apparatus. Its 
use should be so restricted. Therefore, until a 
better word is suggested, the term function will 

* Dictionnaire de Medicine, de Chirurgie, etc. D'apres le 
plan suivi par Nysten. Douzieme edition. Par E. Littre ct 
Ch. Robin, Paris, 1865. 



JO PROPER ANATOMICAL TERMS 

be used, in this work, in connection with the act 
of an apparatus. 

May not the word faculty be applied to the 
activity of an organ, as for example, the gly- 
cogenic faculty of the liver ? 

Crabb defines " a faculty as a specific power 
which is directed to one single object ; it is the 
power of acting according to a given form." 

Lewes, in commenting upon faculty and func- 
tion, says : " ... By faculty is commonly under- 
stood the power or aptitude of an agent to per- 
form a certain action or class of actions. It is 
thus synonymous with function, which means the 
activity of an organ, the uses of the instrument. 
I propose to detatch faculty from this general 
signification, limiting it to the action or class of 
actions into which a function may be diversified 
by the education of experience. That is to say, 
let function stand for the native endowment of 
an organ, and faculty for its acquired variation of 
activity." * 

If the word faculty be used to denote the act, 
the use, the aptitude, of an organ, it should not 
be detatched from its general signification and 
should " stand for the native endowment of an 



* Problems of Life and Mind. By George Henry Lewes. 
American edition. Boston, 1879, p. 27. 



IN CLASSIFICATION. 7 1 

organ," and function should be restricted to the 
act of an apparatus. 

One of the conclusions drawn from the forego- 
ing considerations is that there is no urinary 
system. The kidneys are the uropoietic organs 
of the urinary apparatus ; they secrete the ma- 
terials which enter into the composition of the 
urine ; in them the urine is concocted and is then 
transmitted by their excretory ducts to its proper 
reservoir. The urinary organs are the kidneys ; 
their excretory ducts, the ureters ; and the grand 
reservoir of the urine, the bladder. These organs, 
together with the urethra and the prostate, con- 
stitute the urinary apparatus. It is by means of 
this apparatus that the function of elimination, 
from the body, of certain effete substances, is 
brought to its completion. 

Another conclusion is that there is no geni- 
tal system. The testicles are simply the spermo- 
poietic organs of the genital apparatus. The 
genital organs are the testicles ; the deferential 
canals ; and the seminal vesicles ; these organs 
together with the urethra, the prostate, and the 
penis, constitute the genital apparatus by which 
the function of generation is accomplished under 
proper conditions. 

The uro-gemtal apparatus comprises the urin- 
ary apparatus and the genital apparatus. 



72 PROPER ANATOMICAL TERMS. 

The organs of the urinary apparatus and those 
of the genital apparatus are so intimately asso- 
ciated and so interdependent that they must act 
in perfect harmony or the double apparatus is 
affected in a greater or less degree. Diseases of 
any of the urinary organs cause some derange- 
ment of the others and disturb the genital organs 
and often the whole organism. 






SECTION II. 

Human Nosography. 

A summary of the progress of nosography since its founda- 
tion. The scope of nosography. Notice of Sauvages. A 
consense of views necessary in methodical arrangement. 
Synopses of Sauvages', Cullen's, Parr's, Good's and Delorme's 
arrangements of diseases. Comments on these several systems. 
Cullen's rules for distinguishing genera, species, and varieties 
of diseases. Parr's rules. Some of the aphorisms relating to 
classification, extracted principally from the philosophia 
botanica of Linnaeus, by Doctor Thomas Young. 

ORIGIN AND PROGRESS OF NOSOGRAPHY. 

An outline of the development of nosography 
may, with advantage, be traced from its founda- 
tion to the present time, and be followed by a 
brief commentary upon the methods employed 
by some of the nosographers of the last and of 
this century. 

Nosography is in reality the science of medi- 
cine and therapy is its art. Nosography in- 
cludes the description, the definition, the nomen- 
clature, and the classification of diseases. A 
knowledge of the several branches of anatomy 
is the essential preliminary to the study of noso- 



74 ORIGIN AND PROGRESS OF NOSOGRAPHY. 

graphy. The physician who is thoroughly 
acquainted with this science is a master of the 
natural history of diseases. The training neces- 
sary to its acquirement gives him a precision in 
diagnosis, and a degree of wisdom in prognosis 
and of skill in therapy, to which otherwise he 
could never attain. 

The word nosography* is of comparatively 
modern application. It was not in use among the 
ancient physicians.f Although the study of the 
history of diseases began with the founder of 
medical art and was faithfully continued by his 
successors, no attempt at their classification 
seems to have been made until about the close of 
the sixteenth century. Andreo Cesalpino, X the 
Italian physician and naturalist, was probably the 
first to suggest the methodical arrangement of 



* Nosography, from vodoS, disease, and ypdcpeir, to de- 
scribe. 

t The works of the ancient authors, such as Hippocrates, 
Galen, Celsus, and others, contain no synopses of classifica- 
tion, but their description of diseases is often very accurate 
and much of their nomenclature is still in use. Although the 
Arabian physicians were close followers of the doctrines of 
Aristotle, nothing that can be called a methodical classifica- 
tion of diseases has been found in their treatises. 

\ Cesalpino was born at Arezzo in the year 1519 and 
died in 1603. 



ORIGIN AND PROGRESS OF NOSOGRAPHY. 75 

diseases. This however was not attempted until 
the beginning of the seventeenth century when, 
in 1602, Felix Platerus, of Basle, published, in his 
" Praxeos Medicae" the plan of a nosographical 
method, but went no farther. Among other con- 
tributions were, the " Nosologia " of Warenius of 
Leipsic, 1605; the "Nosologia Harmonica, Dog- 
matiga, et Hermetica" of Petraeus of Marburg, 
1614; the "Idea Universalis Medicinae, of John- 
stonus of Amsterdam, published in 1644, with a 
section devoted to classification, wherein are 
arranged all diseases into three classes, divided 
into internal and external diseases ; and finally, in 
1675, the "Nosologia" of Schoenfeld. All these 
essays were incomplete and of little use except 
that they were the forerunners of the good work 
which was subsequently performed. Such was 
the extent of the progress of nosography, which 
then stood still for half a century. Sydenham 
and Baglivius,* who wrote toward the end of 
the seventeenth century, were of opinion that 
diseases should be classified, like systems of 
botany, by genera and species with characteristic 
definitions. Other physicians of their time were 
of the same opinion (Cullen). It appears, how- 



* Georgii Baglivi, De Praxi Medica, etc., Lugduni Batavo- 
rum, 1700. 



?6 ORIGIN AND PROGRESS OF NOSOGRAPHY. 

ever, that this was not attempted until the year 
1732, when Francois Boissier de Sauvages of 
Montpellier published an essay with the title of 
" Nouvelles Classes de Maladies Disposees dans un 
Ordre semblable d celui des Botanist es." From this 
preliminary essay he built up his " Nosologia 
Methodica" which he did not publish until 1760, 
after nearly thirty years of diligent labor. Men- 
tion should also be made of the nosographical 
contribution of Hebenstreit of Leipsic, 1754. 
But Sauvages was really the founder of method- 
ical nosography to which he gave the greatest 
impulse. He was followed by Linnaeus, Vogel, 
Cullen, Sagar, Macbride, Vitet, Darwin, Selle, 
Pinel, Baumes, Tourdes, Tourtelle, Recamier, 
Crichton, Parr, Swediaur, Young, Richerand, 
Good, Alibert, Hosack, and others who, in some 
instances, subtracted from, or added to, without 
materially changing, his great plan the frame- 
work of which they all retained while they made 
very little change in his nomenclature, much of 
which is still in use. 

Sauvages was a man of brilliant mind and ex- 
traordinary industry. He had been prepared for 
his task of founding the science of nosography by 
a broad and liberal education. He had studied 
and taught botany, and his tastes brought him 
into close relations with the renowned Linnaeus. 



ORIGIN AND PROGRESS OF NOSOGRAPHY. J? 

He had for counselor the illustrious Boerhaave, 
from whom he received much encouragement in 
the prosecution of his difficult and arduous la- 
bors. He cheerfully accepted, and profited by, 
the criticisms of his contemporaries, and lived to 
complete, but not to see in print, the last revision 
of his gigantic work which was not published 
until a year after his death. Sauvages had en- 
tered the medical profession at an early age, and 
had passed a little over one year in Paris where 
he gathered the material for an essay upon 
fevers. His first nosographical essay was pub- 
lished in 1732. He then wrote upon inflamma- 
tion, upon capillary vessels, upon hemiplegia, 
and upon rabies. He wrote also a physiological 
conspectus which was published at Lyons in 
1 751; upon a theory of the circulation of the 
blood ; upon the effects of medicaments ; upon 
embryology; upon tumors; muscular move- 
ments ; elements of physiology ; difficult respira- 
tion ; vision ; a theory of convulsions ; method- 
ical pathology ; and finally came his Nosologia 
Methodica. This was the crowning work, for after- 
wards only a few dissertations appeared from his 
fertile pen, and he died, full of honors, on Febru- 
ary 19th, 1767, at the age of sixty-one, after an 
illness of two years duration. 

To exemplify the estimation in which this 



78 ORIGIN AND PROGRESS OF NOSOGRAPHY. 

truly great physician was held, the following is 
quoted from Good's Physiological system of 
Nosology 1823. 

" The Nosologia Methodica, for such is the 
title of Mr. de Sauvages' work, is indeed, an 
Herculean labour. It consists, in its latest and 
most perfect form, of three distinct arrangements 
— a symptomatical, an aetiological, and an ana- 
tomical ; so as to accommodate itself to the taste 
of the old school as well as of the new. The 
symptomatical, to which the others are pro- 
fessedly subordinate, is by far the most extens- 
ively elucidated ; and comprises ten classes, (each 
introduced by an elaborate pathological sjmop- 
sis), upwards of forty orders, more than three 
hundred genera, and an almost innumerable host 

of species We have yet, however, to add the 

varieties, which under several species are not 
few ; and to bear in mind that to every variety, 
species and genus, as far as their relative charac- 
ters will allow, are allotted a definition, list of 
synonyms, history, diagnosis, prognosis, and 
mode of cure; with, frequently, an exemplifica- 
tion of cases, and a brief statement of the peculiar 
opinions of other writers, before we can fairly 
appreciate the entire mass of matter with which 
the volumes of Mr. de Sauvages abound. He 
seems, indeed, to have been desirous of collecting 






ORIGIN AND PROGRESS OF NOSOGRAPHY. 79 

materials of every kind and quality from every 
quarter to which a market was open ; and of fol- 
lowing up every deviation from health into all 
its possible as well as its actual shades and rami- 
fications " 

The followers of Sauvages, from Linnaeus to 
Hosack were all men of much general and scien- 
tific culture. None of these eminent men was 
better endowed with those requisite qualities 
than the celebrated Cullen, who in the edition of 
his works prepared in 1827 by Doctor John 
Thomson, paraphrases an aphorism of the illus- 
trious Aristotle as follows : 

" Perfect division and definition is the summit 
of human knowledge in every part of science, 
and requires not only the clearest but the most 
comprehensive views, such as, with respect to 
diseases, we can arrive at only by often-repeated 
exercises and much study." 

Cullen further says, " The attempt may at first 
appear uncouth and difficult, but by repetition it 
will become more familiar and easy, and you 
must be content to make such a progress. When 
a little more than thirty years ago, I first got a 
sight of the botanical system of Linnaeus, it ap- 
peared to me to be a piece of the most uncouth 
jargon and minute pedantry ; but, by length of 
time, it is now as familiar to me as my mother 



80 A CONSENSE OF VIEWS NECESSARY 

tongue ; and with whatever difficulty it was first 
received in most parts of Europe, it has now sur- 
mounted these, and its utility has reconciled 
every person to the study of it." 



A CONSENSE OF VIEWS NECESSARY IN 
METHODICAL ARRANGEMENT. 

The earliest medical authors realised the im- 
portance of arrangement* in the elucidation of 
their teachings, but formed no concerted plan. 
The effect of this lack of common agreement was 
the adoption of many differing methods. Most 
of these early writers divided their works into 
parts, books, chapters, and sections. Some of 
them adopted the synoptic, and others the sys- 
tematic method. Later the method of the bota- 
nists was adopted ; and the arrangement of dis- 
eases into classes, orders, genera and species, has, 
ever since, been used by the systematic writers. 
The systematic method has been variously modi- 
fied : (i,) by the adoption of an alphabetical ar- 
rangement of diseases ; (2,) by the arrangement 



* " Without arrangement, no art or science can be acquired, 
for in its absence none can be treated of or communicated." 
(J. M. Good.) 



IN METHODICAL ARRANGEMENT. 8 1 

of diseases, in accordance with their duration, 
into acute and chronic diseases ; (3,) by the 
arrangement of diseases in accordance with the 
anatomical regions of the body, such as the 
head, the trunk, and the extremities ; (4,) by the 
arrangement of diseases in accordance with their 
aetiology ; (5,) by the arrangement of dis- 
eases in accordance with the sex and age of the 
patients ; and (6,) by the arrangement of dis- 
eases in accordance with their symptoms. The 
last named arrangement having been suggested 
by Platerus and first effected by Sauvages. 
In order to convey to the mind a correct idea 
of the arrangement adopted by the nosographers 
of the past, a synopsis of the classes of the most 
prominent among them is introduced. But the 
synopses of Sauvages, Cullen, Parr, Good, and 
Delorme, are given entire to enable the student 
to conveniently examine and compare these 
several systems. Sauvages' system (1 732-1 767), 
representing the beginning of the science ; Cul- 
len's system (1 769-1 790), showing the progress 
made up to his time; Parr's system (1809), ex- 
hibiting a marked change, not however for the 
better, ^classification, while the nomenclature is 
little changed ; Good's system (1822), showing a 
very great improvement in classification though 
not in nomenclature ; and Raige-Delorme's sys- 



82 NOMENCLATURE OF HIPPOCRATES. 

sytem (1S4IJ. being a fair specimen of the de- 
cline of nosographv in France. 

As it may be useful to students of nosography 
to have before them some of the most ancient 
terms used in medicine, a part of the nomen- 
clature of Hippocrates is here inserted in order 
that they may see at a glance those ancient words 
which are retained in the existing medical nomen- 
clature. 



eticai list :? diseases upon which 
crates has written, being a fair 
exemplification of his 

nomenclature* 



I AbsCCSSeS 

3 Alopecia 

4 Anasarca 

5 Anchylosis 

6 Anus, inflamed 

7 " hard tubercles of or near the 
ippetite, canine 

9 " , loss of 



* From M Ifedkal Dictionary. Third edition, 

London. i~ : 



NOMENCLATURE OF HIPPOCRATES. 83 

10 Aphthae 

11 Apolepsis 

12 Apoplexy 

13 Arms, shortness of the 

14 Ascarides 

15 Asthma 

16 Auante 

17 Baldness 

18 Barrenness 

19 Biles 

20 Bladder, tubercles in the 

21 Blood, spitting of 

22 " , vomiting 

23 Blotches, red on the legs, from sitting by 

the fire 

24 Brain, concussion of the 

25 " , ruptured vessels in the 

26 Breath, foetid 

27 " , straightness of the 

28 Buboes 

29 Carbuncle 

30 Catamenia: disordered, natural 

31 Catoche 

32 Cancers 

33 Cams 

34 Cataphora 

35 Cachexy 

36 Catarrh 



34 



NOMENCLATURE OF HIPPOCRATES. 



37 Caries 

38 Cheek, a sphacelous of the 

39 Chilblains 

40 Cholera morbus 

41 Chalk stones in the joints 

42 Cough 

43 Corjza 

44 Coma 

45 " vigil 

46 Contractions of the fibres 

47 Consumption, of the whole body 

48 " , ischiadic 

49 " , nephritic 

50 Colour, bad 

51 Crookedness 

52 Deafness 

53 Delirium 

54 Defluxion or rheum 

55 Diarrhoea 

56 Dreams, frightful 

57 Dumbness 

58 Dysentery 

59 Dyspnoea 

60 Dysury 

61 Ears, pains in the 

62 " , redundant moisture in the 

63 " , ringing in the 

64 " , tubercles about the 



NOMENCLATURE OF HIPPOCRATES. 85 



65 Ecchymosis from contusion 


66 


Empyema 


67 


Emprosthotonos 


68 


Epilepsy 


69 


" , in children 


70 


Epinyctides 


7i 


Erysipelas 


72 


Eruption on the skin 


73 


Evil 


74 


Eye, distortion of the 


75 


" , bleared 


76 


" , dry-bleared 


77 


" , clouds in the 


78 


" , cicatrices in the 


79 


11 , pearls in the 


80 


" , white spots in the 


81 


" , ruptured 


82 


" , exulcerated 


33 


11 , inflamed 


84 


" , dry inflammation of the 


85 Eye-lids, excressences on the 


86 


" , tumid outward 


87 


11 , coalesence of the 


88 


" , scabby 


89 


" , tumors on the 


90 


Face, hard tubercles on the 


9i 


Favi 


92 


Fainting 



86 NOMENCLATURE OF HIPPOCRATES. 

93 Fevers 

94 Fistulas 

95 Fractures 

96 Freckles 

97 Gangrene 

98 Glaucoma 

99 Green sickness 

100 Griping of the intestines 

101 Gout 

102 Gonorrhoea benigna 

103 Gums, black 

104 " , pains in the, from teething 

105 " , tubercles on the 

106 Haemorrhages 

107 Haemorrhoids 

108 Hearing, dull 

109 Heartburn 

no Head, heaviness of the 
in " , ache 

112 " , scurvy 

113 Herpes 

114 Hesitation 

115 Hiccough 

116 Horror 

117 Hoarseness 

118 Humors, discharge of morbid 

119 Hysterics 

120 Hypersarcosis 



NOMENCLATURE OF HIPPOCRATES. 87 

121 Jaundice 

122 Illiac passion 

123 Impotence 

124 Inflammation: external, internal 

125 Itch 

126 Itching 

127 " , a pungent, in the mouth 

128 Kidnies, disorders of the 

129 Labour, difficult 

130 Leprosy 

131 " , the white 

132 Lethargy 

133 Leucophlegmatia 

134 Lientery 

135 Lips, fissures in the 

136 Limping 

137 Liver, inflamed 

138 Lochia, disordered 

139 Lungs, spasmodically contracted 

140 " , varix in the 

141 " , suppurated 

142 " , crude tubercles in the 

143 Luxations 

144 Madness 

145 Melancholy 

146 Mind, alienation of the 

147 " , alienation through melancholy 

148 Miscarriage 



88 NOMENCLATURE OF HIPPOCRATES. 

149 Mole 

150 Mouth, distorted 

151 Nauseating food 

152 Navel, inflamed 

153 Neck, a hard tumor in the 

154 Nose, a discharge of pus in the 

155 Nocturnal pollutions 

156 Nyctalops 

157 Opisthotonos 

158 Orthopnea 

159 Pain, in the loins 

160 Palpitation 

161 Peripneumony 

162 Phlyctaenae 

163 Phrenitis 

164 Phrontis 

165 Placenta, adhering 

166 Plague 

167 Pleurisy 

168 " , a dry 

169 " , a moist 

170 Polypus, in the nose 

171 Pterygion 

172 Pustules, from acrid sweat 

173 Pudenda, excressences of the 

174 " , putrefaction of the 

175 Pupil of the eye, too small or angular 

176 " " " " , exulcerated 



NOMENCLATURE OF HIPPOCRATES. 89 

177 Pupil of the eye, cicatrix of the 

178 " " " " , spoiled 

179 " " " " , removed from its natural 

situation 

180 " M " " , prominent 

181 Ouinsey, affecting the lungs 

182 Restlessness 

183 Rheum, a defluxion of 

184 Ruptures 

185 Salivation, a spontaneous 

186 Sciatica 

187 Scurvy 

188 Sensation, suddenly lost 

189 Shivering 

190 Sight, a privation of 

191 Skin, desquamations of the 

192 Speech, too volatile 

193 Spleen, swelled 

194 " , inflamed 

195 Spine, distorted forwards 

196 Sprains 

197 Sphacelus 

198 Stertor 

199 Strangury 

200 Stone 

201 Stupidity 

202 Stammering 

203 Superfetation 



9 o 



NOMENCLATURE OF HIPPOCRATES. 



204 Tabes dorsalis 

205 Teeth, stupor of the 



206 


" , gnashing and grinding of the 


207 


" , ache 


208 


" , of both jaws fixed together 


209 


Tetanus 


210 


Tetters 


211 


Testicles, swelled 


212 


Tenesmus 


213 


Terminthi 


214 


Tonsils, disorders of the 


215 


" , swelled 


2l6 


Torpidness of the body 


217 


Tongue, fissured 


218 


" , tumor under the 


219 


Trichosis 


220 


Tubercles of various sorts 


221 


Tumors 


222 


Uvula, relaxed 


223 


" , retracted 


224 


" , putrefied 


225 


Uterus, disorders of the 


226 


" , falling down of the 


227 


Ulcers 


228 


Urine, retained 


229 


Urethra, caruncles or tubercles in the 


230 


Voice, loss of the 


231 


Varices 



SAUVAGES' SYSTEM. 91 



232 Vertigo 

233 Warts 

234 Worms 

235 Whitlow 

236 Wry neck 

237 Wounds 

238 White flux 
339 Yawning 



SYNOPSIS OF THE CLASSES, ORDERS, AND 
GENERA OF SAUVAGES' SYSTEM. 

CLASSIS 1. VITIA. 
Ordo I. Maculae. 



Genus 1. 
11 2. 

11 3- 

" 4- 
" 5. 
" 6. 


Leucoma. 

Vitiligo. 

Ephelis. 

Gutta rosea. 

Naevus. 

Ecchymoma. 




Ordo II. Efflorescentiae. 


Genus 7. 
" 8. 
" 9. 
" 10. 


Herpes. 
Epinyctis. 
Psydracia. 
Hidroa. 



92 SYNOPSIS OF 

Ordo III. Phymata. 

Genus 1 1. Erythema. 

12. Oedema. 

13. Emphysema. 

14. Scirrhus. 

15. Phlegmone. 

16. Bubo. 

17. Parotis. 

18. Furunculus. 

19. Anthrax. 

20. Cancer. 

21. Paronychia. 

22. Phimosis. 

Ordo IV. Excrescentiae. 

Genus 23. Sarcoma. 

24. Condyloma. 

25. Verruca. 

26. Pterygium. 

27. Hordeolum. 

28. Bronchocele. 

29. Exostosis. 

30. Gibbositas. 

31. Lordosis. 

Ordo V. Cystides. 

Genus 32. Aneurysma. 

" 33- Varix. 



SAUVAGES' SYSTEM. 93 



Genus 34. Hydatis. 

" 35. Marisca. 

" 36. Staphyloma. 

" 37. Lupia. 

" 38. Hydrarthrus. 

11 39. Apostema. 

11 40. Exomphalus. 

11 41. Oscheocele. 



ORDO VI. ECTOPIAE. 



Genus 42. Exophthalmia. 

43. Blepharoptosis. 

44. Hypostophyle. 

45. Paraglossa. 

46. Proptoma. 

47. Exania. 

48. Exocyste. 

49. Hysteroptosis. 

50. Enterocele. 

51. Epiplocele. 

52. Gasterocele. 

53. Hepatocele. 

54. Splenocele 

55. Hysterocele. 

56. Cystocele. 

57. Encephalocele. 

58. Hysteroloxia. 

59. Parorchydium. 



94 



SYNOPSIS OF 



Genus 60. Exarthrema. 
" 61. Diastasis. 
" 62. Laxarthrus. 



Ordo VII. Plagae. 



Genus 63. Vulnus. 

64. Punctura. 

65. Excoriatio. 

66. Contusio. 

67. Fractura. 

68. Fissura. 

69. Ruptura. 

70. Amputatura. 

71. Ulcus. 

72. Exulceratio. 

73. Sinus. 

74. Fistula. 

75. Rhagas. 

76. Eschara. 

77. Caries. 

78. Arthrocace. 



CLASSIS II. FEBRES. 

Ordo I. Continuae. 



Genus 79, Ephemera. 
" 80. Synocha. 
" 81. Synochus. 



SAUVAGES SYSTEM. g$ 



Genus 


82. 


Typhus. 


<< 


83. 


Hectica. 

Ordo 11. Remittentes. 


Genus 84. 


Amphimerina. 


<( 


85. 


Tritaeophya. 


<< 


86. 
( 


Tetartophya. 

DRDO III. INTERMITTENT! 


Genus 


' 87. 


Quotidiana. 


" 


88. 


Tertiana. 


<< 


89. 


Quartana. 


<< 


90. 


Erratica. 



CLASSIS III. PHLEGMASIAE. 
Ordo I. Exanthematicae. 



91. 


Pestis. 


92. 


Variola. 


93- 


Pemphigus. 


94. 


Rubeola. 


95. 


Miliaris. 


96. 


Purpura. 


97- 


Erysipelas. 


98. 


Scarlatina. 


99. 


Effera. 


100. 


Aphtha. 



g6 SYNOPSIS OF 



Genus 101. 


Phrenitis. 


" I02. 


Paraphrenesis. 


IO3. 


Pleuritis. 


" IO4. 


Gastritis. 


" IO5. 


Enteritis. 


106. 


Epiploitis. 


" IO7. 


Metritis. 


" 108. 


Cystitis. 


Ordo III. Parenchymatosae 


Genus 109. 


Cephalitis. 


" no. 


Cynanche. 


" III. 


Carditis. 


" 112. 


Peripneumonia. 


II3. 


Hepatitis. 


" II4. 


Splenitis. 


" II 5 . 


Nephritis. 



CLASSIS IV. SPASMI. 

Ordo I. Tonici Partiales. 

Genus 116. Strabismus. 

" 117. Trismus. 

118. Obstipitas. 

" 119. Contractura. 

" 120. Crampus. 

" 121. Priapismus. 



SAUVAGES' SYSTEM. 97 

Ordo II. Tonci Generales. 

Genus 122. Tetanus. 
" 123. Catochus. 

Ordo III. Clonici Partiales. 

Genus 124. Nystagmus. 

11 125. Carphologia. 

" 126. Pandiculatio. 

11 127. Apomyttosis. 

" 128. Convulsio. 

" 129. Tremor. 

" 130. Palpitatio. 

u 131. Claudicatio. 

Ordo IV. Clonici Generales. 

Genus 132. Rigor. 

" 133. Eclampsia. 

" 134. Epilepsia. 

" 135. Hysteria. 

" 136. Scelotyrbe. 

" 137. Beriberia. 

CLASSIS V. ANHELATIONES. 
Ordo I. Spasmodicae. 

Genus 138. Ephialtes. 
" 139. Sternutatio. 
" 140. Oscedo. 



9 8 


SYNOPSIS OF 


Genus 141 


Singultus. 


142. 


Tuffis. 




Ordo II. Oppres 


Genus 143 


Stertor. 


" 144. 


Dyspnoea. 


" 145. 


Asthma. 


146. 


Orthopnoea. 


" 147. 


Angina. 


148. 


Pleurodyne. 


" 149. 


Rheuma. 


150. 


Hydrothorax. 


" 151 


Empyema. 



CLASSIS VI. DEBILITATES. 

Ordo I. Dysaesthesiae. 



Genus 


152. 


Cataracta. 




i 


153- 


Caligo. 




1 


154. 


Amblyopia 




1 


155. 


Amaurosis. 




1 


156. 


Anosmia. 




1 


157. 


Agheustia. 




1 


158. 


Dysecoea. 




i« 


159. 


Paracusis. 




u 


l60. 


Cophosis. 




a 


l6l. 


Anaesthesia. 



SAUVAGES SYSTEM. 



99 



Genus 



Genus 



Genus 



162 
163, 
164. 



165 
166 
167 
168 
169 
170 
171 



172. 

173. 
174. 

175. 



Ordo II. Anepithymiae. 

Anorexia. 

Adipsia. 

Anaphrodisia. 

Ordo III. Dyscinesiae. 

Mutitas. 

Aphonia. 

Psellismus. 

Paraphonia. 

Paralysis. 

Hemiplegia. 

Paraplegia. 

Ordo IV. Leipopsychiae. 

Asthenia. 

Leipothemia. 

Syncope. 



Genus 



176. 
177. 
178. 
179. 
180. 
181. 
182. 



Asphyxia. 
Ordo V. 

Catalepsis. 

Ecstasis. 

Typhomania. 

Lethargus. 

Cataphora. 

Cams. 

Apoplexia. 



Com ata. 



IOO 



SYNOPSIS OF 



CLASSIS VII. DOLORES. 







Ordo I. Vagi 


mu 


s 183. 


Arthritis. 


u 


184. 


Ostocopus. 


(i 


185. 


Rheumatismus. 


(< 


186. 


Catarrhus. 


n 


IS/. 


Anxietas. 


u 


188. 


Lassitude 


(< 


I89. 


Stupor. 


ti 


I9O. 


Pruritus. 


t( 


I 9 I. 


Algor. 


11 


192. 


Ardor. 



Ordo II. Capitis. 

Genus 193. Cephalalgia. 

" 194. Cephalaea. 

" 195. Hemicrania. 

11 196. Ophthalmia. 

" 197. Otalgia. 

" 198. Odontalgia. 

Ordo III. Pectoris. 

Genus 199. Dysphagia. 
" 200. Pyrosis. 
" 201. Cardiogmus. 



SAUVAGES' SYSTEM. IOI 

Ordo IV. Abuominales INTERNL 

Genus 202. Cardialgia. 

" 203. Gastrodynia. 

" 204. Colica. 

" 205. Hepatalgia. 

" 206. Splenalgia. 

" 207. Nephralgia. 

" 208. Dystocia. 

" 209. Hysteralgia. 

Ordo V. Externi et artuum. 

Genus 210. Mastodynia. 

11 211. Rhachialgia. 

11 212. Lumbago. 

" 213. Ischias. 

" 214. Proctalgia. 

" 215. Pudendagra. 



CLASSIS VIII. VESANIAE. 

Ordo I. Hallucinationes. 
Genus 216. Vertigo. 



" 217. 


Suffusio. 


218. 


Diplopia. 


" 219. 


Syrogmos. 


M 220. 


Hypochondriasis. 


" 221. 


Somnambulismus. 



102 



SYNOPSIS OF 



ORDO II. MOROSITATES. 



Genus 222. Pica. 

223. Bulimia. 

224. Polydipsia. 

225. Antipathia. 

226. Nostalgia. 

227. Panophobia. 

228. Satyriasis. 

229. Nymphomania. 

230. Tarantismus. 

231. Hydrophobia. 



Ordo III. Deliria. 



Paraphrosyne. 

Amentia. 

Melancholia. 

Mania. 

Demonomania. 



Genus 232. 

" 233. 

" 234. 

" 235. 

236. 

Ordo IV. Vesaniae anomalae. 



Genus 237. Amnesia. 
" 238. Agrypnia. 



CLASSIS IX. FLUXUS. 
Ordo I. Sangninfluxus. 

Genus 239. Haemorrhagia. 
" 240. Haemoptysis. 



SAUVAGES SYSTEM. 



I03 



Genus 


241. 


Stomacace. 


<( 


242. 


Haematemesis. 


«< 


243. 


Haematuria. 


11 


244. 


Menorrhagia. 


11 


245. 


Abortus. 

Ordo II. Alvifluxus. 


Genus 


246. 


Heptirrhoea. 


a 


247. 


Haemorrhois. 


<« 


248. 


Dysenteria. 


ll 


249. 


Melaena. 


<< 


250. 


Nausea. 


ll 


251. 


Vomitus. 


11 


252. 


Ileus. 


<< 


253- 


Cholera. 


u 


254. 


Diarrhoea. 


it 


255. 


Caeliaca. 


u 


256. 


Lienteria. 


<« 


257 


Tenesmus. 
Ordo III. Serifluxus 


Genus 


258 


Ephidrosis. 


11 


259 


Epiphora. 


<< 


260 


Coryza. 


<« 


261. 


Ptyalismus. 


11 


262. 


Anacatharsis 


" 


263 


Diabetes. 


11 


264 


Enuresis. 



104 


SYNOPSIS OF 


Genus 265. 


Dysuria. 


" 266. 


Pyuria. 


" 267. 


Leucorrhoea. 


" 268. 


Gonorrhoea. 


" 269. 


Dyspermatismus. 


" 270. 


Galactirrhoea. 


" 271. 


Otorrhoea. 




Ordo IV. Acrifluxus 


Genus 272. 


Flatulenta. 


" 273. 


Aedopsophia. 


" 274. 


Dysodia. 



CLASSIS X. CACHEXIAE. 
Ordo I. Macies. 



Genus 275. 


Tabes. 


276. 


Phthisis. 


" 277. 


Atrophia. 


" 278. 


Aridura. 


Ordo II. Intumescentiae 


Genus 279. 


Polysarcia. 


280. 


Pneumatosis. 


281. 


Anasarca. 


282. 


Phlegmatia. 


" 283. 


Physconia. 


284. 


Graviditas. 



SAUVAGES SYSTEM. 



105 



Ordo III. Hydropes Partiales. 



Genus 285. 


Hydrocephalus. 


" 286. 


Physocephalus. 


" 287. 


Hydrorhachitis. 


" 288. 


Ascites. 


" 289. 


Hydrometra. 


290. 


Physometra. 


" 291. 


Tympanites. 


" 292. 


Meteorismus. 


" 293. 


Ischuria. 




Ordo IV. Ti 


Genus 294. 


Rhachitis. 


" 2 95- 


Scrophula. 


" 296. 


Carcinoma. 


" 297. 


Leontiasis. 


11 298. 


Malis. 


M 299. 


Framboesia. 




Ordo V. Impe 


Genus 300. 


Syphilis. 


" 301. 


Scorbutus. 


" 302. 


Elephantiasis. 


" 303. 


Lepra. 


" 304. 


Scabies. 


" 305. 


Tinea. 



IOD 


COMMENTS ON 




ORDO VI. ICTERITIAE. 


Genus 306. 


Aurigo. 


" 307. 


Melasicterus. 


" 308. 


Phaenigmus. 


309. 


Chlorosis. 


Ordc 


> VII. Cachexiae ano: 


Genus 310. 


Phthiriasis. 


" 3"- 


Trichoma. 


" 312. 


Alopecia. 


" 313. 


Elcosis. 


" 314- 


Gangraena. 


" 315. 


Necrosis. 



In his nosologia methodica, Sauvages enumerates 
ten classes, forty-four orders, three hundred and 
fifteen genera and many species and varieties. 

Many of the orders contain genera that bear 
no relation with each other. For instance in the 
third order, phymata, of the first class, vitia, are 
included erythema, emphysema, scirrhus, bubo, 
anthrax, cancer, paronychia and phimosis. In 
the fourth order excrescentiae, are placed sarcoma, 
condyloma, pterygium, bronchocele, and exos- 
tosis. In the fifth order cystides are, aneurysm, 
varix, marisca (piles), staphyloma, hydrarthrus, 
and oscheocele. 

In the second class are arranged the fevers, in 



SAUVAGES SYSTEM. IO7 

three orders, continued, remittent, and intermit- 
tent, and twelve genera. 

In the first order exanthematicae, of the third 
class, pJdegmasiae, are placed the plague, small pox, 
measles, purpura, erysipelas, and aphtha. In the 
second order membranaceae, are phrenitis, pleuri- 
tis, gastritis, metritis, and cystitis. In the third 
order, parenchymatosae, are cephalitis, carditis, 
nephritis, etc. 

There are many other defects in this system 
which now make it of little use, but it should be 
borne in mind that medicine has greatly ad- 
vanced since the time of Sauvages, and that his 
classification is one of the great factors in this 
advance. He used, to the best advantage, the 
knowledge and the material which he possessed, 
and his system made a profound impression on 
the profession. 

Sauvages had an enthusiastic admirer in Lin- 
naeus who, after following the Sauvagian system, 
for nearly twenty years, in his lectures at Upsala, 
caused to be published (in 1759), a classification 
of diseases prepared, under his direction, by one 
of his disciples. Afterwards he, himself, pre- 
pared and published (in 1763), a new classifica- 
tion of diseases very similar to that of Sauvages 
and consisting of eleven classes: 1, Exanthema- 
tici ; 2, Critici; 3, Phlogistici ; 4, Dolorosi ; 5, 



108 LINNAEUS, VOGEL. 

Mentales ; 6, Quietales ; 7, Motorii ; 8, Sup- 
pressorii ; 9, Evacuatorii ; 10, Deformes ; 11, 
Vitia : thirty-seven orders, and three hundred 
and twenty-six genera. 

In comparing this nosographical table with 
that of Sauvages, says Pinel, it is easily seen 
that descriptive medicine had not made great 
progress under the fertile pen of Linnaeus. 

Linnaeus was soon followed by Vogel of Got- 
tingen who, (in 1764), published a classification of 
diseases consisting of eleven classes: 1, Febres ; 
2, Profluvia ; 3, Epischeses ; 4, Dolores; 5, 
Spasmi ; 6, Adynamiae ; 7, Hyperaestheses ; 
8, Cachaexiae ; 9, Paranoiae ; 10, Vitia; 11, 
Deformitates, and five hundred and sixty genera. 

Vogel introduces three new classes : (3,) Epis- 
cheses, (6,) Adynamiae, and (7,) Hyperaestheses ; 
and places phlegmasiae among the vices. 

The nosology of Cullen was first published in 
1769, and was followed by several revisions. It 
contains four classes, nineteen orders, one hun- 
dred and fifty genera, nearly six hundred species, 
and many varieties. A synopsis of the classes, 
orders, and genera, is here introduced for com- 
parison with the preceding systems. 



CULLEN S SYNOPSIS. 



IO9 



cullen's synopsis of classes, orders and 

genera of diseases. partly from 

the edition of 1827. 

CLASSIS 1. PYREXIAE. 
Ordo I. Febres. 
Sectio 1. Intermittentes. 
Tertiana. 



Genus 1. 

2. 
" 3- 



Quartana. 

Quotidiana. 

Sectio 2. Contimiae. 
Genus 4. Synocha. 
11 5. Typhus. 
" 6. Synochus. — Hectica. 

Ordo II. Phlegmasiae. 

Genus 7. Phlogosis — Apostema. 
Gangrena — Sphacelus. 

8. Ophthalmia. 

9. Phrenitis. 

10. Cynanche. 

11. Pneumonia. — Vomica. Empyema, 

12. Carditis. 

13. Peritonitis. 

14. Gastritis. 

15. Enteritis. 

16. Hepatitis. 



no cullen's synopsis. 

Genus 17. Splenitis. 

" 18. Nephritis. 

" 19. Cystitis. 

" 20. Hysteritis. 

" 21. Rheumatismus — Arthrodynia. 

" 22. Odontalgia. 

" 23. Podagra. 

" 24. Arthropuosis. 

Ordo III. Exanthemata. 



Genus 


' 25. 


Variola. 


a 


26. 


Varicella. 


<< 


27. 


Rubeola. 


<( 


28. 


Scarlatina. 


(i 


29. 


Pestis. 


(< 


30. 


Erysipelas. 


<< 


3i. 


Miliaria. 


<< 


32. 


Urticaria. 


<< 


33- 


Pemphigus. 


<i 


34- 


Aphtha. 



Ordo IV. Haemorrhagiae. 

Genus 35. Epistaxis. 

" 36. Haemoptisis. Phthisis. 

" 37. Haemorrhois. 

11 38. Menorrhagia. 

" 39. Catarrhus. 

" 40. Dysenteria. 



CULLEN S SYNOPSIS. 



I I 



CLASSIS II. NEUROSES. 

ORDO I. COMATA. 



Genus 



Genus 



Genus 



41. 


Apoplexia. 


42. 


Paralysis. — Tremor. 




Ordo II. Adynamiae. 


43- 


Syncope. 


44 


Dyspepsia. 


45- 


Hypochondriasis, 


46. 


Chlorosis. 




Ordo III. Spasmi. 


47- 


Tetanus. 


48. 


Trismus. 


49. 


Convulsio. 


50. 


Chorea. 


51. 


Raphania. 


52. 


Epilepsia. 


53- 


Palpitatio. 


54 


Asthma. 


55. 


Dyspnoea. 


56. 


Pertussis. 


57- 


Pyrosis. 


58. 


Colica. 


59- 


Cholera. 


60. 


Diarrhoea. 


61. 


Diabetes. 



112 cullen's synopsis. 

Genus 62. Hysteria. 
" 63. Hydrophobia. 

Ordo IV. Vesaniae. 

Genus 64. Amentia. 

" 65. Melancholia. 

66. Mania. 

" 6y. Oneirodynia. 

CLASSIS III. CACHEXIAE. 

Ordo I. Marcores. 

Genus 68. Tabes. 
" 69. Atrophia. 

Ordo II. Intumescentiae. 

Sectio 1. Adiposae. 

Genus 70. Polysarcia. 

Sectio 2. Flatuosae. 

Genus 71. Pneumatosis. 
" 72. Tympanites. 
" 73. Physometra. 

Sectio j. Aquosae. 

Genus 74. Anasarca. 
" 75. Hydrocephalus. 
11 j6. Hydrorachitis. 



CULLEN S SYNOPSIS. 



113 



Genus JJ. 


Hydrothorax. 


" 78. 


Ascites. 


- 79- 


Hvdrometra. 


" 80. 


Hydrocele. 




Seetio 4. Solidae. 


Genus 81. 


Physconia. 


" 82. 


Rachitis. 




Ordo III. Impetigines 


Genus 83. 


Scrophula. 


84. 


Syphilis. 


" 85. 


Scorbutus. 


" S6. 


Elephantiasis. 


" 87. 


Lepra. 


" 88. 


Frambesia. 


" 89. 


Trichoma. 


M 90. 


Icterus. 



CLASSIS IV. LOCALES. 
Ordo I. Dysaesthesiae. 



Geuus 91 


Caligo. 


" 92 


Amaurosis. 


" 93- 


Dysopia. 


" 94- 


Pseudoblepsis 


" 95- 


Dysecoea. 


« 9 6 


Paracusis. 



114 cullen's synopsis. 

Genus 97. Anosmia. 
98. Agheustia. 
" 99. Anaesthesia. 

Ordo II. Dysorexiae. 
Sectio 1. Appetitus Erronei. 

Genus 100. Bulimia. 

" 101. Polydipsia. 

" 102. Pica. 

" 103. Satyriasis. 

" 104. Nymphomania. 

" 105. Nostalgia. 

Sectio 2. Appetitus deficiens. 

Genus 106. Anorexia. 
" 107. Adipsia. 
" 108. Anaphrodisia. 

Ordo III. Dyscinesiae. 



Genus 109. 


Aphonia. 


no. 


Mutitas. 


in. 


Paraphonia. 


112. 


Psellismus. 


" 113. 


Strabismus. 


" 114. 


Dysphagia. 


" 115. 


Contractura. 



cullen's synopsis. 



115 









Ordo IV. Apocenoses. 


Genus 


116. 


Profusio. 


<< 


117. 


Ephidrosis. 


a 


118. 


Epiphora. 


it 


119. 


Ptyalismus. 


11 


120. 


Enuresis. 


<< 


121. 


Gonorrhoea. 

Ordo V. Epischeses. 


Genus 


122. 


Obstipatio. 


(i 


123. 


Ischuria. 


<< 


I24. 


Dysuria. 


a 


125. 


Dyspermatismus. 


<< 


126. 


Amenorrhoea. 
Ordo VI. Tumores. 


Genus 


127. 


Aneurysma. 






128. 


Varix. 






I29. 


Ecchymoma. 






I30. 


Scirrhus. 






131- 


Cancer. 






132. 


Bubo. 






133- 


Sarcoma. 






134. 


Verruca. 






135- 


Clavus. 






136. 


Lupia. 






137. 


Ganglion. 



n6 




SAGAR. 


Genus 


138. 


Hydatis. 




a 


139- 


Hydrarthrus 




a 


140. 


Exostosis. 








Ordo VII. 


ECTOPIAE. 


Genus 


141. 


Hernia. 




a 


142. 


Prolapsus. 




a 


143. 


Luxatio. 








Ordo VIII. 


DlALYSES. 


Genus 


144. 


Vulnus. 






145. 


Ulcus. 






146. 


Herpes. 






147- 


Tinea. 






148. 


Psora. 






149. 


Fractura. 






150. 


Caries. 





The simplicity and superiority of Cullen's sys- 
tem over those of his predecessors are easily 
valued, and show how much progress, in descrip- 
tive medicine, was made from 1760 to 1769, but it 
leaves much to be desired. Its defects are not 
few, and many of the enumerated genera are, in 
reality, species or only symptoms. 

Sagar of Vienna published (1771-1776) a sys- 
tem of classification of diseases which is such as 
to constitute a retrogressive step in nosology. It 



MACBRIDE, SELLE, VITET. WJ 

consists of thirteen classes : I, Vitia ; 2, Plagae ; 
3, Cachexiae ; 4, Dolores ; 5, Fluxus ; 6, Sup- 
pressiones ; 7, Spasmi ; 8, Anhelationes ; 9, De- 
bilitates ; 10, Exanthemata; 1 1, Phlegmasiae ; 
12, Febres ; 13, Vesaniae : fifty-four orders; 
three hundred and fifty-one genera ; and twenty- 
five hundred species. 

Macbride (1772) counts four classes : 1, Uni- 
versal diseases; 2, Local diseases; 3, Sexual 
diseases ; 4, Infantile diseases : twenty-three or- 
ders ; and one hundred and eighty genera. 

Selle's " Iconographia systematis morborum natn- 
ralis" (1773) contains eighteen classes: 1, In- 
flammatory diseases ; 2, Putrid diseases ; 3, 
Bilious diseases ; 4, Pituitous diseases ; 5, Verm- 
inous diseases ; 6, Lacteous diseases ; 7, Nervous 
diseases ; 8, Periodic diseases ; 9, Obstructions ; 
10, Gouty diseases; 11, Rachitic diseases; 12, 
Scrophulous diseases; 13, Cancerous diseases; 
14, Venereal diseases; 15, Psoric diseases; 16, 
Scorbutic diseases; 17, Diseases produced by 
venoms; 18, Organic diseases: and forty-seven 
genera. 

This and the four preceding systems were very 
poor competitors of Cullen's nosology which was 
finally, in France at least, replaced by Pinel's 
nosology. 

Vitet (1778,) arranges diseases into eight 



Il8 DARWIN, PINEL, BAUMES. 

classes: i, Fevers; 2, Inflammations ; 3, Pain- 
ful diseases ; 4, Convulsions ; 5, Debilities ; 6, 
Evacuatory diseases ; 7, Diseases by retention 
of the solid and liquid matters ; 8, Diseases of 
the mind : forty-three orders, and three hundred 
and ninety-four genera. (A worse system even 
than Sagar's.) 

Darwin (1794-1796) adopts four classes: 1, 
Diseases of irritation ; 2, Diseases of sensation ; 3, 
Diseases of volition ; 4, Diseases of association : 
eleven orders ; forty-one genera ; and four hun- 
dred and seventy-seven species. (An original and 
ingenious, but inconsistent, obscure and unprac- 
tical system.) 

Pinel's (1798,) nosographie philosophique consists 
of five classes : 1, Fevers; 2, Phlegmasiae ; 3, 
Haemorrhages ; 4, Neuroses ; 5, Organic le- 
sions : twenty-two orders ; and one hundred 
and forty-one genera. 

Baumes published in 1801 a work with the 
title of Fondemens de la science methodique des 
maladies, in which he regards diseases as likely to 
result from the increase or from the diminution 
of certain chemical agents existing in the animal 
economy, such as caloric, oxygen, nitrogen, 
hydrogen, and phosphorus. This arrangement 
consists of five classes ; several sub-classes ; 



BAUMES. 119 

ninety-seven genera ; and a great number of 
species and sub-species. 

CLASS I. Calorineses : diseases in which 
the dominant phenomena seem to consist of an 
alteration in the quantity of animal heat. 

Sub-class 1. Supercalorineses : diseases caused 
by an augmentation of the animal heat. 

Sub-class 2. Discalorineses : diseases in which 
the predominant phenomena seem to be owing to 
a diminution of the animal heat. 

CLASS II. Oxygeneses ; diseases in which 
the state of the system seems to be allied to an 
alteration in the normal quantity of oxygen in 
the economy. 

Sub-class 1. Disoxygeneses : diseases caused 
by a notable diminution in the quantity of oxygen 
in the body. 

Sub-class 2. Superoxygeneses : diseases where 
the oxygen is in excess. 

CLASS III. Hydrogeneses : diseases in 
which the mucous secretion, the fats, the bile, 
the milk, offer characters of predominence or 
degeneration. 

CLASS IV. Azoteneses : essentially putrid 
diseases, formed by the predominence of nitrogen 
in the economy. 

CLASS V. Phosphoreneses : diseases attrib- 



120 TOURDES. 

uted to an excess or a diminution of the phos- 
phate of lime, or to its decomposition. 

Supplementary class. This class contains seven 
genera and certain sub-genera consisting princi- 
pally of traumatisms. 

Pinel and Bricheteau, from whose article this 
and several of these abstracts were made, say, 
" We have almost nothing to say of Mr. Baumes' 
nosology, composed in a moment of efferves- 
cence, This work, long since judged, is 

already of the domain of history, and is a new 
proof of the great errors which may be com- 
mitted by a man of talent " 

Tourdes published, in 1803, a new classification 
of diseases, consisting of four classes, nineteen 
orders, and fifty-one genera, founded upon the 
existence of three elementary tissues which he 
says form the basis of all the organs ; these are 
the nervous, fibrous, and cellular or lymphatic, 
tissues. 

Class I. Diseases of the fibrous or irritable 
tissue. 

Class II. Diseases of the nervous and sens 
tive tissue. 

Class III. Diseases of the cellular or lyi 
phatic tissue. 

Class IV. Complicated diseases. This class 






RECAMIEF. 121 

embraces simultaneous diseases of several sys- 
tems or different tissues. 

Tourtelle, in his Elemens de medecine Theorique 
et Pratique (1805,) inserts a system of nosology in 
which diseases are divided into six classes ; one 
hundred and eighty-two genera ; and seven 
hundred and nine species. 

Class I. Pyrexiae. 
Class II. Flux. 
Class III. Suppressions. 
Class IV. Neuroses. 
Class V. Cachexiae. 
Class VI. Vitia. 



Re'camier's system of nosology, extracted from 
the article of Pinel and Bricheteau in the Die- 
tionaire des Sciences Medicales 18 19, is as fol- 
lows : 



FIRST SECTION. Physiological diseases. 

Class I. Alterations of the secretions. 
Class II. Phlegmasiae. 
Class III. Fevers. 
Class IV. Neuroses. 
Class V. Cachexiae. 



122 CRICHTON. 



SECOND SECTION. Anatomical diseases. 

Class VI. Solution of the tissues. 

Class VII. Displacements. 

Class VIII. Physical vices of the arterial, ven 
ous or lymphatic circulation. 

Class IX. Physical vices of the digestive, lacry- 
mal, salivary, bilious, urinary 
spermatic, and uterine excretions. 

Class X. Deformities, congenital or accidental. 

Class XL Foreign bodies. 

Each class contains four orders, and certain 
genera and species. 

Crichton's system consists of eight classes; 
thirty orders ; and one hundred and seventy- 
eight genera. 

Parr, the author of the London Medical Dic- 
tionary, who so ably criticised the nosographers 
that were contemporaneous with, or preceded 
him, omitted classes and recognized only orders, 
of which he made twelve; genera, thirty-four; 
species, two hundred and twenty-one ; and a 
number of sub-species and of varieties. 

The following is a synopsis of Parr's system 
from which most of the species and all the sub- 
species and varieties are omitted. 






23 



SYNOPSIS OF PARR'S SYSTEM. 

Order I. Pyrexiae. 

Genus I. Intermittens. 
[5 species]. 

Genus II Exaccrbans. 
[3 species]. 

Genus III. Continua. 



Sp. 1. Synocha. 
11 2. Typhus. 

[3 sub-species]. 
" 3. Synochus. 





Order II. 


Phlegmasiae. 




Genus I. 


Inflammatio. 


p. I. 


Phlegmon. 




" 2. 


Ophthalmia. 




" 3- 


Phrenitis. 




" 4- 


Cynanche. 




" 5- 


Pneumonia. 




" 6. 


Hepatitis. 




11 7- 


Carditis. 




" 8. 


Gastritis. 




" 9- 


Enteritis. 




" 10. 


Nephritis. 




" 11. 


Cystitis. 





124 



SYNOPSIS OF PARR S SYSTEM. 



Sp. 


12. 


Hysteritis. 




ti 


13- 


Odontalgia. 








[Various sub-species]. 






Genus II. 


Phlogosis. 


Sp. 


I. 


Erythema. 




it 


2. 


Phrenitica. 




a 


3- 


Anginosa. 




a 


4 


Pneumonica. 




it 


5. 


Puerperahs. 








Genus III. 


Catarrhus. 


Sp. 


1. 


Coryza. 

[4 sub-species]. 




a 


2. 


Dysenteria. 




a 


3- 


Phthisis. 




a 


4. 


Coeliaca. 




ti 


5- 


Leucorrhoea. 




ti 


6. 


Cystirrhoea. 




tt 


7- 


Gonorrhoea. 




a 


8. 


Leucorrhois. 








Genus IV. 


Arthritis. 






[4 species]. 






Genns V. 


Exostosis. 


Sp 


1. 


Periostea. 





SYNOPSIS OF PARR'S SYSTEM. 1 25 

Order III. Eruptiones. 

Genus I. Exanthemata. 

[13 species]. 

Genus II Efflorescentia. 
[9 species]. 

Order IV. Profluvia. 

Genus I. Haemorrhagia. 
[9 species, including Haematuria]. 

Genus II. Apocenosis, 
[9 species, including Diabetes and Diuresis.] 







Order V. 


SUPPRESSORII 






Genus I, 


Constrictoria. 


Sp. 


I. 


Dysphagia. 




{< 


2. 


Obstipatio. 




II 


3- 


Polypus. 








Genus II. 


Anhelatio. 


Sp. 


I. 


Asthma. 




<< 


2. 


Dyspnoea. 

[8 sub-species]. 








Genus III 


, Epischesis. 






[9 species, ; 


among which] 


Sp. 


5. 


Ischuria 
a. Renalis 





126 SYNOPSIS OF PARR'S SYSTEM. 

b. Ureterica 

c. Vesicalis 

d. Urethralis. 
Sp. 6. Dysuria 

a. Ardens 

b. Spasmodica 

c. Compressionis 

d. Irritata. 

" 8. Dyspermatismus 

a. Organicus 

b. Spasmodicus. 

Order VI. Spasmi. 



Sp. 





Genus I. Tonos. 


I. 


Trismus. 


2. 


Tetanus. 


3- 


Contra ctura. 


4- 


Priapisraus. 


5- 


Strabismus. 




Genus II. Cloitos, 




[u species]. 



Order VII. Adynamiae. 

Genus I. Coma. 
[4 species]. 



SYNOPSIS OF PARR S SYSTEM. 



127 



Sp. I. 

2. 

3- 
4- 

5- 

6. 



Sp. 1. 
" 2. 



Genus II. AncpitJiymia. 
[7 species]. 

Order VIII. Paranoiae. 

Genus I. Morositas. 
[3 species]. 

Genus II. Hallucinatio. 



Sp. 1. Satyriasis. 
" 2. Nymphomania. 
" 3. Erotomania. 



Genus III. Vesania. 
[3 species]. 

Order IX. Cachexiae. 

Genus I. Impetigo. 

Scorbutus. 

Syphilis. 

Aurigo. 

Phaenigmus. 

Melasma. 

Rubigo. 

Genus II. Macula. 

Ecchymosis. 
Petechia. 



128 SYNOPSIS OF PARR'S SYSTEM. 

Order X. Intumescentiae. 

Genus I. Tuber. 
[16 species]. 

Genus II. Phlegmatia. 
[8 species, including Hydrocele]. 

Genus III. Cystis. 
[6 species]. 

Genus IV. Emphysema. 
[3 species]. 

Order XI. Ectopiae. 

Genus I. Hernia. 
[8 species]. 

Genus II. Prolapsus, 
[y species, including Exocyste]. 

Genus III. Luxatio. 
[21 species]. 

Order XII. Plagae. 

Genus I. Dialysis, 
[7 species]. 

Genus II Clasis. 
[4 species]. 



SWEDIAUR, YOUNG, RICHERAND. I2Q 

Genus III. Diastasis. 
Sp. 1. Symphisis Pubis. 

Swediaur enumerates live classes, thirty-two 
orders ; and one hundred and thirty-eight genera. 

Young, in his system of practical nosology, 
adopts five classes: (1,) Paraneurismi, diseases 
of the nervous and muscular system ; (2,) Par- 
haemasiae, diseases of the sanguiferous system ; 
(3,) Pareccrises, diseases of the secretions ; (4,) 
Paramorphiae, structural diseases: (5,) Ectopiae, 
displacements : seven orders ; and seventy-nine 
genera. 

Richerand, in his nosographie chirurgicale, fourth 
edition, adopts only three classes : (1,) Physical 
lesions resulting from the action of a mechanical 
cause ; (2,) Organic or structural lesions ; (3,) 
Vital lesions : and fourteen orders. 

Richerand afterwards introduced a new classi- 
fication consisting of eight classes: (1,) Diseases 
which affect all the organic systems ; (2,) Dis- 
eases of the sensitive apparatus ; (3,) Diseases of 
the locomotory apparatus ; (4,) Diseases of the 
digestive apparatus ; (5,) Diseases of the circula- 
tory apparatus ; (6,) Diseases of the respiratory 
apparatus ; (7,) Diseases of the cellular system ; 
(8,) Diseases of the sexual organs : and sixteen 
orders. 



130 good's table of classification. 

Good's system comprises six classes: (i,) 
Coeliaca, diseases of the digestive function ; (2,) 
Pneumatica, diseases of the respiratory function ; 
(3,) Haematica, diseases of the sanguineous func- 
tion ; (4,) Neurotica, diseases of the nervous func- 
tion; (5,) Genetica, diseases of the sexual func- 
tion ; (6,) Eccritica, diseases of the excernent 
function ; and is further divided into orders, 
genera and species, as follows. 



DOCTOR GOOD'S " TABLE OF CLASSIFICATION." * 

CLASS. I. COELIACA. 

Diseases of the digestive function. 

Ord. I. Enterica. 
Affecting the alimentary canal. 

Gen. I. Odontia, 
Misdentition. 

Spec. 1. O. Dentitionis, (Teething.) 
" 2. " Dolorosa, (Toothache.) 
" 3. " Stuporis, (Toothedge.) 
" 4. " Deformis, (Deformity of the teeth.) 



* Extracted from " The Study of Medicine," Vol. I, 
London, 1822. 



GOODS TABLE OF CLASSIFICATION. 131 

Spec. 5. O. Edentula, (Toothlessness.) 

" 6. " Incrustans, (Tartar of the teeth.) 
u 7. " Excressens, (Excrescent gums.) 

Gen. II. PtyalismuSy 
Ptyalism. 

Spec. 1. P. Acutus, (Salivation.) 

" 2. " Chronicus, (Chronic ptyalism.) 
11 3. " Iners, (Drivelling.) 

Gen. Ill, Dysphagia, 
Dysphagy. 

Spec. 1. D. Constricta, (Constrictive dysphagy.) 

" 2. " Atonica, (Atonic disphagy.) 

" 3. " Globosa, (Nervous quinsy.) 

" 4. " Uvulosa, (Uvular dysphagy.) 

" 5. " Linguosa, (Lingual disphagy.) 

Gen. IV. Dip sos is, 
Morbid thirst. 

Spec. 1. D. Avens, (Immoderate thirst.) 
" 2. " Expers, (Thirstlessness.) 

Gen. V. Limosis, 
Morbid appetite. 

Spec. 1. L. Avens, (Voracity.) 
" 2. " Expers, (Long fasting.) 



Spec. 


3- 


tt 


4- 


tt 


5- 


tt 


6. 


a 


7- 



132 good's table of classification. 

" Pica, (Depraved appetite.) 
" Cardialgia, (Heart-burn, Water- 
brash.) 
" Flatus. (Flatulency.) 
" Emesis, (Sickness, vomiting.) 
" Dyspepsia, (Indigestion.) 

Gen. VI. Colica, 
Colic. 

C. Ileus, (Iliac passion.) 
" Rhachialgia, (Colic of Poitou, Pain- 
ters colic.) 
" Cibaria, (Surfeit.) 
" Flatulenta, (Wind colic.) 
" Constipata, (Constipated colic.) 
" Constricta, (Constrictive colic.) 

Gen. VII. Coprostasis, 
Costiveness. 

Spec. 1. C. Constipata, (Constipation.) 
" 2. " Obstipata, (Obstipation.) 

Gen. VIII Diarrhoea, 
Looseness. 

Spec. 1. D. Fusa, (Feculent looseness.) 
" 2. " Biliosa, (Bilious looseness.) 



Spec. 


I. 


tt 


2. 


It 


3- 


u 


4. 


tt 


5- 


it 


6. 






133 



)ec. 


3- 


ii 


4- 


ii 


5- 


ii 


6. 


ii 


7- 


ii 


8. 



11 Mucosa, (Mucous looseness.) 

" Chylosa, (Chylous looseness.) 

" Lienteria, (Lientery.) 

11 Serosa, (Serous looseness.) 

11 Tubularis, (Tubular looseness.) 

" Gypsata, (Gypseous looseness.) 

Gen. IX. Cholera, 
Cholera. 

Spec. i. C. Biliosa, (Bilious cholera.) 
11 2. " Flatulenta, (Wind cholera.) 
" 3. " Spasmodica, (Spasmodic cholera.) 

Gen. X. Enterolithus, 
Intestinal concretions. 

Spec. 1. E. Bezoardus, (Bezoar.) 

11 2. " Calculus, (Intestinal calculus.) 
" 3. " Scybalum, (Scybalum.) 

Gen. XI. Hehninthia, 
Worms. 

Spec. 1. H. Alvi, (Alvine worms.) 
" 2. " Podicis, (Anal worms.) 
" 3. " Erratica, (Erratic worms). 



134 GOODS TABLE OF CLASSIFICATION. 

Gen. XII. Proctica, 
Proctica. 

Spec. I. P. Simplex, (Simple proctica.) 

11 2. " Spasmodica, (Spasmodic stricture of 

the rectum.) 
" 3. " Callosa, (Callous stricture of the 

rectum.) 
11 4. " Tenesmus, (Tenesmus.) 
" 5- " Marisca, (Piles.) 
" 6. " Exania, (Prolapse of the fundament.) 

Ord. II. Splanchnica, 
Affecting the collatitious viscera. 

Gen. I. Icterus, 
Yellow Jaundice. 

Spec. 1. I. Choloeus, (Biliary jaundice.) 

" 2. " Chololithicus, (Gall-stone jaundice.) 

" 3. " Spasmodicus, (Spasmodic jaundice.) 

" 4. " Hepaticus, (Hepatic jaundice.) 

" 5. " Infantum, (Jaundice of infants.) 

Gen. II. Melaena, 
Melena. 

Spec. 1. M. Choloea, (Black, or green jaundice.) 
" 2. " Cruenta, (Black vomit.) 



good's table of classification. 



135 



Gen. III. Chololithus y 
Gall-stone. 

Spec. 1. C. Ouiescens, (Quiescent gall-stone.) 
" 2. " Means, (Passing of gall-stones.) 



Spec. 1 



Gen. IV. Parabysmci) 
Visceral turgescence. 

P. Hepaticum, (Turgescence of the 
liver.) 

" Splenicum, (Turgescence of the 
spleen.) 

11 Pancreaticum, (Turgescence of the 
pancreas.) 

" Mesentericum, (Turgescence of the 
mesentery.) 

" Intestinale, (Turgescence of the in- 
testines.) 

" Omentale, (Turgescence of the 
omentum.) 

" Complicatum, (Turgescence com- 
pounded of various 
organs.) 



136 good's table of classification. 

CLASS. II. PNEUMATICA. 

Diseases of the respiratory function. 

Ord. I. Phonica, 
Affecting the vocal avenues. 

Gen. I. Coryza, 
Running at the nose. 

Spec. 1. C. Entonica, (Entonic coryza.) 
" 2. " Atonica, (Atonic coryza.) 

Gen. II. Polypus, 
Polypus. 

Spec. 1. P. Elasticus, (Compressible polypus.) 
" 2. " Coriaceus, (Cartilaginous polypus.) 

Gen. III. Rhonchus, 
Rattling in the throat. 

Spec. 1. R. Stertor, (Snoring.) 
" 2. " Cerchnus, (Wheezing.) 

Gen. IV. Aphonia, 
Dumbness. 

Spec. 1. A. Elinguium, (Elingual dumbness.) 
" 2. " Atonica, (Atonic dumbness.) 
" 3. " Surdorum, (Deaf-dumbness.) 



good's table of classification. 137 

Gen. V. DyspJionia, 
Dissonant voice. 

Spec. 1. D. Susurrans, (Whispering voice.) 
" 2. " Puberum, (Voice of puberty.) 
" 3. " Immodulata, (I m melodious voice.) 

Geu. VI. Psellismus, 
Dissonant speech. 

Spec. 1. P. Bambalia, (Stammering.) 
" 2. " Blaesitas, (Misenunciation.) 

Ord. II. Pneumonica, 

Affecting the lungs, their membranes, or motive 

power. 

Gen. I. Bex, 
Cough. 

Spec. 1. B. Humida, (Common or tumid cough.) 
11 2. " Sicca, (Dry cough.) 
" 3. " Convulsiva, (Hooping cough.) 

Gen. II. Larjmgysmus, 
Laryngic suffocation. 

Spec. 1. L. Stridulus, (Stridulous constriction of 

the larynx.) 



138 good's table of classification. 

Gen. III. Dyspnoea, 
Anhelation. 

Spec. I. D. Chronica, (Short-breath.) 

" 2. " Exacerbans, (Exacerbating anhela- 
tion.) 

Gen. IV. Asthma, 
Asthma. 

Spec. 1. A. Siccum, (Dry or nervous asthma.) 
" 2. " Humidum, (Humid or common 

asthma.) 

Gen. V. Ephialtes, 
Incubus. 

Spec. 1. E. Vigilantium, (Day-mare.) 
" 2. " Nocturnus, (Night-mare.) 

Gen. VI. Sternalgia, 
Suffocative breast-pang. 

Spec. 1. S. Ambulantium, (Acute breast-pang.) 
" 2. " Chronica, (Chronic breast-pang. 

Gen. VII Fleuralgia, 
Pain in the side. 

Spec. 1. P. Acuta, (Stitch.) 

" 2. " Chronica, (Chronic pain in the side.) 



good's table of classification. 139 

CLASS. III. HAEMATICA, 

Diseases of the sanguineous function. 

Ord. I. Pyretica, 
Fevers. 

Gen. I. Ephemera, 
Diary fever. 

Spec. 1. E. Mitis, (Wild diary fever.) 
" 2. " Acuta, (Acute diary fever.) 
" 3. " Sudatoria, (Sweating fever.) 

Gen. II Anetus, 
Intermitting fever. Ague. 

Spec. 1. A. Quotidianus, (Quotidian ague.) 
" 2. »' Tertianus, (Tertian ague.) 
" 3- " Quartanus, (Quartan ague.) 
" 4. " Erraticus, (Irregular ague.) 

" 5. " Complicatus, (Complicated ague.) 

Gen. III. Epanetns, 
Remittent fever. 

Spec. I. E. Mitis, (Wild remittent.) 

" 2. " Malignus, (Malignant remittent.) 
" 3. " Hectica, (Hectic fever.) 



140 GOOD S TABLE OF CLASSIFICATION. 

Gen. IV. Enecia, 
Continued fever. 

Spec. i. E. Cauma, (Inflammatory fever.) 
" 2. " Typhus, (Typhus fever.) 
" 3- " Synochus, (Synochal fever.) 

Ord. II. Phlogotica, 
Inflammations. 

Gen. I. Apostema, 
Aposteme. 

A. Commune, (Common aposteme.) 
" Psoaticum, (Psoas abscess.) 
" Hepaticum, (Abscess of the liver.) 
" Empyema, (Lodgement of matter in 
the chest.) 
" 5. " Vomica, (Vomica.) 

Gen. II. Phlegrnone, 
Phlegmon. 

Spec. 1. P. Communis, (Common phlegmon.) 

2. " Parulis, (Gum boil.) 

3. " Auris, (lmposthume in the ear.) 

4. " Parotidea, (Parotid phlegmon.) 

5. " Mammae, (Abscess of the breast.) 

6. « Bubo, (Bubo.) 

7. " Phimotica, (Phimotic phlegmon.) 



Spee. 


I, 


<< 


2. 


tt 


3- 


n 


4. 



GOOD S TABLE OF CLASSIFICATION. 141 

Gen. III. FAyma, 
Tubercle. 

Spec. 1. P. Hordeolum, (Sty.) 

" 2. " Furunculus, (Boil.) 

" 3. " Sycosis, (Sycous phyma.) 

" 4. " Anthrax, (Carbuncle.) 

Gen. IV. Ionthus, 
Whelk. 

S/>ec. 1. I. Varus, (Stone-pock.) 

" 2. " Corymbifer, (Carbuncled face, Rosy 

drop.) 

Gen. V. Phlysis, 
Phlysis. 

Spec. 1. P. Paronychia, (Whitlow.) 

Gen. VI. Erythema, 
Inflammatory blush. 

Spec. 1. E. Oedematosum, (Edematous inflam- 
mation.) 

14 2. " Erysipelatosum, (Erysipelatous in- 
flammation.) 

" 3. " Gangraenosum, (Gangrenous inflam- 
mation.) 

11 4. " Vesiculare, (Vesicular inflammation.) 



142 



good's table of classification. 



Spec. 5. E. Pernio, (Chilblain.) 
" 6. " Intertrigo, (Fret.) 



Gen. V II. Empresma, 
Visceral inflammation. 



Spec. 1. E. Cephalitis, (Inflammation of the 

brain.) 
" 2. " Otitis, (Ear-ache.) 
" 3. " Parotitis, (Mumps.) 
" 4. " Paristhmitis, (Quinsy.) 
" 5. " Laryngitis, (Inflammation of the 

larynx. 
" 6. " Bronchitis, (Croup.) 
" 7. " Pneumonitis, (Peripneumony.) 
" 8. " Pleuritis, (Pleurisy.) 
" 9. " Carditis, (Inflammation of the heart.) 
" 10. " Peritonitis, (Inflammation of the 

peritoneum.) 
" 11. ° Gastritis, (Inflammation of the 

stomach.) 
" 12. " Enteritis,(Inflammation of the bowels.) 
" 13. " Hepatitis, (Inflammation of the liver.) 
" 14. " Splenitis, (Inflammation of the spleen.) 
" 15. " Nephritis, (Inflammation of the 

kidneys ) 
" 16. " Cystitis, (Inflammation of the bladder.) 



Spec. 


I. 


n 


2. 


tt 


3- 


u 


4- 


it 


5- 



GOOD S TABLE OF CLASSIFICATION. 143 

Spec. 17. E. Hysteritis, (Inflammation of the 

womb.) 
" 18. " Orchitis, (Inflammation of the tes- 
ticles.) 

Gen. VIII. Ophthalmia, 
Ophthalmy. 

O. Taraxis, (Lachrymose ophthalmy.) 
" Iridis, (Inflammation of the iris.) 
" Purulenta, (Purulent ophthalmy.) 
" Glutinosa, (Glutinous ophthalmy.) 
" Chronica, (Lippitude, Blear eye.) 

Gen. IX. Catarrhus, 
Catarrh. 

Spec. 1. C. Communis, (Cold in the head or chest.) 
" 2. " Epidemicus, (Influenza.) 

Gen. X. Dysenteria, 
Dysentery. 

Spec. 1. D. Simplex, (Simple dysentery.) 
" 2. " Pyrectica, (Dysenteric fever.) 

Gen. XI. Bucnemia, 
Tumid leg. 

Spec. 1. B. Sparganosis, (Puerperal tumid leg.) 
" 2. " Tropica, (Tumid leg of hot climates.) 



144 good's table of classification. 

Gen. XII. Arthrosia. 
Articular inflammation. 

Spec. i. A. Acuta, (Acute rheumatism.) 

" 2. " Chronica, (Chronic rheumatism.) 

" 3. " Podagra, (Gout.) 

" 4. " Hydrarthrus, (White-swelling.) 

ORD. III. EXANTHEMATICA, 

Eruptive fevers, Exanthems. 

Gen. I. Enanthesis, 
Rash, Exanthem. 

Spec. 1. E. Rosalia, (Scarlet-fever.) 
" 2. " Rubeola, (Measles.) 
" 3. " Urticaria, (Nettle-rash.) 

Gen. II. Emptily sis, 
Ichorous exanthem. 



Spec. 1. 


E. Miliaria, (Miliary fever.) 


" 2. 


" Aphtha, (Thrush.) 


" 3- 


" Vaccinia, (Cow-pox.) 


" 4- 


" Varicella, (Water-pox.) 


" 5- 


" Pemphigus, (Vesicular or bladdery 




fever.) 


" 6. 


" Erysipelas, (St. Anthony's fire.) 



good's table of classification. 145 

Gen. III. Empyesis, 
Pustulous exanthem. 

Spec. 1. E. Variola, (Small-pox.) 

Gen. IV. Anthracia, 
Carbuncular exanthem. 

Spec. 1. A. Pestis, (Plague.) 
" 2. " Rubula, (Yaws.) 

Ord. IV. Dysthetica, 
Cachexies. 

Gen. I. Plethora, 
Plethora. 

Spec. 1. P. Entonica, (Sanguine phthora.) 
" 2. " Atonica, (Serous plethora.) 

Gen. II. Haemorrliagia, 
Haemorrhage. 

Spec. 1. H. Entonica, (Entonic Haemorrhage.) 
" 2. " Atonica, (Atonic Haemorrhage.) 

Gen. III. Marasmus, 
Emaciation. 

Spec. 1. M. Atrophia, (Atrophy.) 

" 2. " Climactericus, (Decay of nature.) 



146 good's table of classification. 

Spec. 3. M. Tabes, (Decline.) 

" 4. " Phthisis, (Consumption.) 

Gen. IV. Struma, 
Scrophula. 

Spec. 1. S. Vulgaris, (King's evil.) 

Gen. V. Carcinus, 
Cancer. 

Spec. 1. C. Vulgaris, (Common' cancer.) 

Gen. VI Lues, 
Venereal disease. 

Spec. 1. L. Syphilis, (Pox.) 

" 2. " Syphilodes, (Bastard pox.) 

Gen. VII. Elephantiasis y 
Elephant-skin. 

Spec. 1. E. Arabica, (Arabian elephantiasis, 

Black leprosy.) 
" 2. " Italica, (Italian elephantiasis.) 
" 3. " Asturiensis, (Asturian elephantiasis.) 

Gen. VIII. Catacausis, 
Catacausis. 

Spec. 1. C. Ebriosa, (Inebriate catacausis.) 



GOOD S TABLE OF CLASSIFICATION. 147 

Gen. IX. Porphyra, 
Scurvy. 

Spec. 1. P. Simplex, (Petecchial scurvy.) 
11 2. " Haemorrhagica, (Land-scurvy.) 
" 3. " Nautica, (Sea-scurvy.) 

Gen. X. Exa?igia, 
Exangia. 

Spec. 1. E. Aneurisma, (Aneurism.) 
" 2. " Varix, (Varix.) 
" 3. " Cyania, (Blue-skin,) 

Gen. XL Gangraena, 
Gangrene. 

G. Sphacelus, (Mortification.) 
" Ustilaginea, (Mildew-mortification.) 
11 Necrosis, (Dry gangrene.) 
" Caries, (Caries.) 

Gen. XII. [7/cus, 
Ulcer. 

Spec. 1. CJ. Incarnans, (Simple healing ulcer.) 
" 2. " Vitiosum, (Depraved ulcer.) 
11 3. " Sinuosum, (Sinuous ulcer.) 
" 4. " Tuberculosum, (Warty, excrescent 

ulcer.) 
" 5. " Cariosum, (Carious ulcer.) 



Spec. 


1. 


n 


2. 


n 


3- 


«< 


4- 



148 good's table of classification. 

CLASS. IV. NEUROTICA, 

Diseases of the nervous function. 

Ord. I. Phrenica, 
Affecting the intellect. 

Gen. I Ecphronia, 
Insanity, Craziness. 

Spec. 1. E. Melancholia, (Melancholy.) 
" 2. " Mania, (Madness.) 

Gen. II. Empathema, 
Ungovernable passion. 

Spec. 1. E. Entonicum, (Empassioned excite- 
ment.) 

" 2. " Atonicum, (Empassioned depres- 
sion.) 

" 3. " Inane, (Hair-brained passion.) 

Gen. III. Alusia, 
Illusion, Hallucination. 

Spec. 1. A. Elatio, (Sentimentalism, Mental ex- 
extravagance.) 
" 2. " Hypochondrias, (Hypochondrism, 
Low spirits.) 



good's table of classification. 149 

Gen. IV. Aphelxia, 
Revery. 

Spec. 1. A. Socors, (Absccnce of mind.) 
" 2. " Intenta, (Abstraction of mind.) 
" 3. " Otiosa, (Brown-study.) 

Gen. V. Paroniria, 
Sleep-disturbance. 

Spec. 1. P. Ambulans, (Sleep-walking.) 
" 2. " Loquens, (Sleep-talking.) 
" 3. " Salax, (Night-pollution.) 

Gen. VI. Moria, 
Fatuity. 

Spec. 1. M. Imbecillis, (Imbecility.) 
" 2. M Demens, (Irrationality.) 

Ord. II. Aesthetica, 
Affecting the sensation. 

Gen. I. Par op sis, 
Morbid sight 

Spec. I. P. Lucifuga, (Night-sight.) 
11 2. " Noctifuga, (Day-sight.) 
" 3. " Longinqua, (Long-sight.) 



Spec 


• 4- 


<< 


5- 


<< 


6. 


<< 


7- 


tt 


8. 


<i 


9- 


<< 


10. 


<< 


11. 


ii 


12. 


a 


13- 



150 good's table of classification. 

P. Propinqua, (Short-sight.) 

" Lateralis, (Skue-sight.) 

" Illusoria, (False-sight.) 

" Caligo, (Opaque cornea.) 

" Glaucosis, (Humoral opacity.) 

" Catarracta, (Cataract.) 

" Synizesis, (Closed pupil.) 

" Amaurosis, (Drop serene.) 

" Staphyloma, (Protuberant eye.) 

" Strabismus, (Squinting.) 

Gen. II. Paracusis, 
Morbid hearing. 

Spec. 1. P. Acris, (Acute hearing.) 

" 2. " Obtusa, (Hardness of hearing.) 

" 3. " Perversa, (Perverse hearing.) 

" 4. " Duplicata, (Double hearing.) 

•' 5. " Illusoria, (Imaginary sounds.) 

" 6. " Surditas, (Deafness.) 

Gen. III. Parosmis y 
Morbid smell. 

Spec. 1. P. Acris, (Acute smell.) 
" 2. " Obtusa, (Obtuse smell.) 
" 3. " Expers, (Want of smell.) 



GOODS TABLE OF CLASSIFICATION. I 5 I 

Gen. IV. Parageusis, 
Morbid taste. 

Spec. i. P. Acuta, (Acute taste.) 
u 2. " Obtusa, (Obtuse taste.) 
" 3. " Expers, (Want of taste.) 

Gen. V. Par apsis, 
Morbid touch. 

Spec. 1. P. Acris, (Acute sense of touch or gen- 
eral feeling.) 

" 2. " Expers, (Insensibility of touch or 
general feeling.) 

" 3. u Illusoria, (Illusory sense of touch or 
general feeling.) 

Gen. VI. Neuralgia, 
Nerve-ache. 

Spec. 1. N. Faciei, (Nerve-ache of the face.) 
" 2. " Pedis, (Nerve-ache of the foot.) 
" 3. " Mammae, (Nerve-ache of the breast.) 



152 



GOOD S TABLE OF CLASSIFICATION. 



Spec. I 
2 

3 
4 
5 
6 

7 
8 



Spec. 


I. 


tt 


2. 


a 


3- 


a 


4- 


it 


5- 


ti 


6. 



ORD. III. ClNETICA, 

Affecting the muscles. 

Gen. I. E?itasia, 
Constrictive spasm. 

E. Priapismus, (Priapism.) 
Loxia, (Wry-neck.) 
Articularis, (Muscular stiff-joint.) 
Systremma, (Cramp.) 
Trismus, (Locked-jaw.) 
Tetanus, (Tetanus.) 
Lissa, (Rabies, Canine madness.) 
Acrotismus, (Suppressed pulse.) 

Gen. II. Clonus, 
Clonic spasm. 

C. Singultus, (Hiccough.) 

" Sternutatio, (Sneezing.) 

" Palpitatio, (Palpitation.) 

" Nictitatio, (Twinkling of the eye 

lids.) 
" Subsultus, (Twitching of the ten 

dons.) 
" Pandiculatio, (Stretching.) 



good's table of classification. 



153 



Spec. 



Gen. III. Sync/onus, 
Synclonic spasm. 

Tremor, (Trembling.) 
Chorea, (St. Vitus' dance.) 
Ballismus, (Shaking palsy.) 
Raphania, (Raphania.) 
Beriberia, (Barbiers.) 



Ord. IV. Systatica, 

Affecting several or all the sensorial powers 
simultaneously. 

Gen. I. Agrypnia, 
Sleeplessness. 

Spec. 1. A. Excitata, (Irritative wakefulness.) 
" 2. " Pertaesa, (Chronic wakefulness.) 

Gen. II. Dysphoria, 
Restlessnes. 

Spec. 1. D. Simplex, (Fidgets.) 
" 2. " Anxietas, (Anxiety.) 

Gen. Ill Antipathia, 
Antipathy. 

Spec. 1. A. Sensilis, (Sensile antipathy.) 

2. M Insensilis, (Insensile antipathy.) 



154 good's table of classification. 







Gen. IV. Cephalaea, 






Head-ache. 


Spec 


I. 

2. 

3- 
4- 
5- 
6. 


C. Gravans, (Stupid head-ache.) 
" Ecstasis, (Ecstasy.) 
" Catalepsia, (Catalepsy.) 
" Lethargus, (Lethargy.) 
" Apoplexia, (Apoplexy.) 
" Paralysis, (Palsy.) 



CLASS. V. GENETICA, 

Diseases of the sexual function. 

Ord. I. Cenotica, 
Affecting the fluids. 

Gen. I. Paramenia, 
Mismenstruation. 

Spec. i. P. Obstructionis, (Obstructed menstrua- 
tion.) 
" 2. " Difficilis, (Laborious mentruation.) 
u 3. " Superflua, (Excessive menstruation.) 
" 4. " Erroris, (Vicarious menstruation.) 
" 5. " Cessationis, (Irregular cessation of 

the menses.) 



good's table of classification. 155 

Genus II. Leucorrhoca, 
Whites. 

Spec. 1. L. Communis, (Common whites.) 
" 2. " Nabothi, (Labour-show.) 
" 3. " Senescentium, (Whites of advanced 

life.) 

Gen. III. BlennorrJioea, 
Gonorrhoea. 

Spec. 1. B. Simplex, (Simple urethral running.) 
" 2. " Luodes, (Clap.) 
" 3. " Chronica, (Gleet.) 

Gen, IV. Spermorrhoea, 
Seminal flux. 

Spec. 1. S. Entonica, (Entonic seminal flux.) 
" 2. " Atonica, (Atonic seminal flux.) 

Gen. V. Galactia, 
Mislactation. 

Spec. 1. G. Praematura, (Premature milk-flow.) 

" 2. " Defectiva, (Deficient milk-flow.) 

" 3. " Depravata, (Depraved milk-flow.) 

" 4. " Erratica, (Erratic milk-flow.) 

11 5. " Virorum, (Milk-flow in males.) 



156 good's table of classification. 

Ord. II. Orgastica, 
Affecting the orgasm. 

Gen. I Chlorosis. 
Green-sickness. 

Spec. 1. C. Entonica, (Entonic green-sickness.) 
" 2. " Atonica, (Atonic green-sickness.) 

Ge?i. II. Proeotia. 
Genital precocity. 

Spec. 1. P. Masculina, (Male precocity.) 
" 2. " Feminina, (Female precocity.) 

Gen. III. Lagnesis, 
Lust. 

Spec. 1. L. Salacitas, (Salacity.) 

" 2. " Furor, (Lascivious madness.) 

Gen. IV. Agenesia, 
Male sterility. 

Spec. 1. A. Impotens, (Male impotency.) 

" 2. " Dyspermia, (Seminal-mis-emission.) 
" 3. " Incongrua, (Copulative incongruity.) 



GOODS TABLE OF CLASSIFICATION. I 57 

Gen. V. Aphoria, 
Female sterility, Barrenness. 

Spec. i. A. Impotens, (Barrenness of impotency.) 
" 2. " Paramenica, (Barrenness of mis-men- 
struation.) 
" 3. " Impercita, (Barrenness of irrespon- 

dence.) 
14 4. " lncongrua, (Barrenness of incon- 
gruity.) 

Gen. VI. Aedoptosis, 
Genital prolapse. 

Spec. 1. A. Uteri, (Falling down of the womb.) 
" 2. " Vaginae, (Prolapse of the vagina.) 
" 3. " Vesicae, (Prolapse of the bladder.) 
" 4. " Complicata, (Complicated genital 

prolapse.) 
" 5. " Polyposa, (Genital excrescence.) 

Ord. III. Carpotica, 
Affecting the impregnation. 

Gen. I. Paracyesis, 
Morbid pregnancy. 

Spec. 1. P. Irritativa, (Constitutional derange- 
ment of pregnancy.) 



158 good's table of classification. 

Spec. 2. " Uterina, (Local derangement of 

pregnancy.) 
11 3. " Abortus, (Abortion.) 

Gen. II. Parodynia, 
Morbid labour. 

P. Atonica, (Atonic labour.) 
" Implastica, (Unpliant labour.) 
" Sympathetica, (Complicated labour.) 
" Perversa, (Preternatural presenta- 
tion.) 
" Amorphica, (Impracticable labour.) 
" Pluralis, (Multiphcate labour.) 
" Secundaria, (Sequential labour.) 

Gen. III. Eccyesis, 
Extra-uterine-fetation. 

Spec. 1. E. Ovaria, (Ovarian exfetation.) 
" 2. " Tubalis, (Tubal exfetation.) 
" 3. " Abdominalis, (Abdominal exfetation.) 

Gen. IV. Pseudocyesis t 
Spurious pregnancy. 

Spec. 1. P. Molaris, (Mole.) 
" 2. " Inanis, (False conception.) 



Spec. 


I. 


a 


2. 


n 


3- 


n 


4- 


ti 


5- 


a 


6. 


<( 


7- 



I 



good's table of classification. 159 

CLASS. VI. ECCRITICA, 

Diseases of the excernent function. 

Ord. I. Mesotica, 
Affecting the parenchyma. 

Gen. I. Polysarcia, 
Corpulency. 

Spec. 1. P. Adiposa, (Obesity.) 

Gen. II. Emphyma, 
Tumour. 

Spec. 1. E. Sarcoma, (Sarcomatous tumour.) 
" 2. " Encystis, (Encysted tumour.) 
" 3. " Exostosis, (Bony tumour.) 

Gen. III. Parostia, 
Mis-ossification. 

Spec. 1. P. Fragilis, (Fragility of the bones.) 
" 2. " Flexilis, (Flexility of the bones.) 

Gen. IV. Cyrtosis, 
Contortion of the bones. 

Spec. 1. C. Rhachia, (Rickets.) 
" 2. " Cretinismus, (Cretinism.) 



160 good's table of classification. 

Gen. V. Osthexia, 
Osthexy. 

Spec. i. O. Infarciens, (Parenchymatous os- 
thexy.) 
" 2. " Implexa, (Vascular osthexy.) 

Ord. II. Catotica, 
Affecting internal surfaces. 

Gen. I. Hydrops, 
Dropsy. 

H. Cellularis, (Cellular dropsy.) 
" Capitis, (Dropsy of the head.) 
" Spinae, (Dropsy of the spine.) 
" Thoracis, (Dropsy of the chest.) 
" Abdominis, (Dropsy of the belly.) 
" Ovarii, (Dropsy of the ovaries.) 
" Tubalis, (Dropsy of the Fallopian 

tubes.) 
" Uteri, (Dropsy of the womb.) 
" Scroti, (Dropsy of the scrotum.) 

Gen. II Emphysema, 
Inflation, Wind-dropsy. 

Spec. i. E. Cellulare, (Cellular inflation.) 
" 2. " Abdominis, (Tympany.) 



Spec. 


I. 


(< 


2. 


u 


3- 


11 


4- 


u 


5- 


il 


6. 


(( 


7- 


it 


8. 


it 


9- 




good's table of classification. 161 

Gen. III. Paruria, 
Mismicturition. 



Spec. I. P. Inops, (Destitution of urine.) 

" 2. " Retentionis, (Stoppage of urine.) 

" 3. " Stillatitia, (Strangury.) 

" 4. " Mellita, (Saccharine urine, Diabetes.) 

" 5. " Incontinens, (Incontinence of urine.) 

" 6. " Incocta, (Unassimilated urine.) 

" 7. " Erratica, (Erratic urine.) 



Gen. IV. Lithiciy 
Urinary calculus. 

Spec. 1. L. Renalis, (Renal calculus.) 

" 2. " Vesicalis, (Stone in the bladder.) 



Ord. III. Acrotica, 
Affecting the external surface. 

Gen. I. EphidrosiSy 
Morbid sweat. 

Spec. 1. E. Profusa, (Profuse sweat.) 

" 2. " Cruenta, (Bloody sweat.) 

" 3. " Partialis, (Partial sweat) 

" 4. " Discolor, (Coloured sweat.) 

" 5. " Olens, (Scented sweat.) 

u 6. " Arenosa, (Sandy sweat.) 



1 62 good's table of classification. 

Gen. II. Exanthesis, 
Cutaneous blush. 

Spec. i. E. Roseola, (Rose-rash.) 



Gen. III. Exormia, 
Papulous skin. 

Spec. I. E. Strophulus, (Gum-rash.) 

" 2. " Lichen, (Lichenous-rash.) 

" 3. " Prurigo, (Pruriginous-rash.) 
" 4. " Milium, (Millet rash.) 



Gen. IV. Lepidosis, 
Scale-skin. 

Spec. 1. L. Pityriasis, (Dandriff.) 

" 2. " Lepriasis, (Leprosy.) 

" 3. " Psoriasis, (Dry-scall.) 

" 4. " Icthyiasis, (Fish-skin.) 

Gen. V. Ecplilysis, 
Blains. 

Spec. 1. E. Pompholyx, (Water-blebs.) 

" 2. " Herpes, (Tetter.) 

" 3. " Rhypia, (Sordid-blain.) 

" 4. " Eczema, (Heat eruption.) 



good's table of classification. 163 



Spec. 



Spec. 



Spec. 



Spec. 1. 
" 2. 



Gen. VI. Ecpyesis, 
Humid scall. 

E. Impetigo, (Running scall.) 
" Porrigo, (Scabby scall.) 
14 Ecthyma, (Papulous scall.) 
" Scabies, (Itch.) 

Gen. VII. Mails, 
Cutaneous vermination. 

M. Pediculi, (Lousiness.) 
" Pulicis, (Flea-bites.) 
" Acari, (Tick-bite.) 
" Filariae, (Guinea worm.) 
" Oestri, (Gad-fly bite.) 
" Gordii, (Hair worm.) 

Gen. VIII. Ecphyma, 
Cutaneous excrescence. 

E. Caruncula, (Caruncle.) 
" Verruca, (Wart.) 
" Clavus, (Corn.) 
" Callus, (Callus) 

Gen. IX. Trichosis, 
Morbid hair. 

T. Setosa, (Bristly hair.) 
" Plica, (Matted hair.) 



164 good's table of classification. 



Spec. 



Spec. 



T. Hirsuties, (Extraneous hair.) 
" Distrix, (Forky hair.) 
" Poliosis, (Gray hairs.) 
" Athrix, (Baldness.) 
" Area, (Areated hair.) 
" Decolor, (Miscolored hair.) 

Gen. X. Epichrosis, 
Macular-skin. 

E. Leucasmus, (Weal-skin.) 

" Spilus, (Mole.) 

11 Lenticula, (Freckles.) 

" Ephelis, (Sun-burn.) 

" Aurigo, (Orange-skin.) 

" Poecilia, (Pye-balled-skin) 

" Alphosis, (Albino-skin.) 



Good's classification is exhaustive but his 
nomenclature very fanciful. The following are 
among the many blemishes contained in his sys- 
tem of classification. 

Abscess of the breast, bubo, and gum-boil, are 
placed as species of the same genus ; sty is in the 
same genus as anthrax ; chilblain with erysipela- 
tous inflammation ; croup with peritonitis, inflam- 
mation of the brain, carditis, nephritis, cystitis, 
etc. ; gout with white swelling ; aphtha with 
pemphigus and erysipelas ; priapism with wry- 



ALIBERT. 165 

neck and locked-jaw, etc., and yet Good is con- 
sidered as the greatest of all classifiers. 

Alibert, in his Nosologic naturelle ou les maladies 
dn corps humain distributes par families, groups 
diseases, in accordance with the organs affected, 
into certain classes, families and genera as fol- 
lows: 

First class. Trophopathies, or diseases which 
attack the functions of assimilation. 

First family. Gastroses, diseases whose princ- 
ipal seat is in the stomach ; thirteen genera. 

Second family. Enteroses, enteric diseases ; 
ten genera. 

Tliird family. Choloses, diseases of the biliary 
apparatus ; eleven genera. 

Fourth family. Uroses, diseases of the urinary 
apparatus ; twelve genera. 

Fifth family. Pneumoses, diseases of the 
respiratory organs ; eight genera. 

Sixth family. Angioses, diseases of the cir- 
culatory system ; nineteen genera. 

Seventh fainily. Leucoses, diseases of the se- 
rous and lymphatic system ; twelve genera. 

Eighth family. Adenoses, diseases of the gland- 
ular system ; five genera. 

Ninth family. Ethmoplecoses, diseases of the 
cellular tissuse ; six genera. 



l66 HOSACK, RAIGE-DELORME. 

Tenth family. Blennoses, diseases of the mu- 
cous membranes ; eleven genera. 

This sj^stem of nosography does not appear to 
have been completed. 

Doctor Hosack's system consists of eight 
classes ; twenty-five orders ; and one hundred 
and ninety-eight genera. 

The Dictionnaire de Medecine, second edition 
Paris 1 841, Volume 23rd, p. 240, contains an 
article with the heading pathologie, by Raige- 
Delorme, and in this article is included a classi- 
fication of diseases which is here reproduced as 
an example of the decline of nosography in the 
country of its birth. 

raige-delorme's classification. 

CLASS I. General diseases whose anatomical 
conditions are unknown. 

Order i. Pyrexiae. 

Genus 1. Essential pyrexiae. 

" 2. Pyrexiae having, besides their febrile 
phenomena, certain constant an- 
atomical or physiological charac- 
ters. 

" 3. Exanthematic pyrexiae. 

" 4. Symptomatic pyrexiae. 



RAIGE-DELORME. 167 

Order 2. General cachaectic diseases. 

(Tuberculosis, melanosis, and the divers 

degenerations.) 

CLASS II. Mixed diseases. 
(General and local.) 

CLASS III. Local diseases. 
Order i. Phlegmasiae. 

Order 2. Haemorrhagiae. 

Order 3. Diseases which result in degenera- 
tion of the tissues ; an analogous or a 
heterologous organic production : 
tubercle, cancer, melanosis, etc. 

Order 4. Dropsies. 

Order 5. Fluxes. 

Order 6. Pneumatoses. 

CLASS IV. Neuroses. — Diseases characterised 

by a trouble in the functions of the nervous 

system, without appreciable textural 

lesions. 

The different genera of neuroses are, 
Neuroses of the cephalo-rhachidian centres ; 



l68 COMMENTS ON DELORME'S SYSTEM. 

Neuroses of the senses ; 
Neuralgiae ; 

Neuroses of the respiratory organs ; 
Neuroses of the heart ; 
Neuroses of the digestive organs. 

CLASS V. Virulent diseases. 
(Syphilis, variola, vaccinia.) 

CLASS VI. Poisoning. 
CLASS VII. Asphyxiae. 

CLASS VIII. Mechanical or Surgical diseases. 

This comparatively modern classification and 
its nomenclature, abound in the greatest inconsis- 
tencies and inaccuracies, and in the most flagrant 
violations of the simplest rules of classification 
and nomenclature, to say nothing of the pathol- 
ogical inaccuracies and the defective definitions. 

The name of the first class is objectionable on 
account of its length and obscurity. The author, 
instead of naming the second genus of the first 
order of this classs, attempts to describe it. In 
the second order of the first class he mixes tuber- 
culosis and melanosis with the " different degen- 
erations " and repeats them in the third order of 



COMMENTS ON DELORME'S SYSTEM. 169 

the third class. The second class is as objection- 
able as the first class. Among the orders of the 
third class are jumbled up, phlegmasiae, haemor- 
rhagiae, dropsies, fluxes, and pneumatoses. He 
defines, and inaccurately too, instead of naming, 
the third order of this third class. 

Taking into consideration the excellent work, 
in the direction of arrangement, performed in 
France for more than a century prior to the ap- 
pearance of this classification, it is past compre- 
hension that so inexact and unsatisfactory a classi- 
fication should have appeared from the pen of a 
writer in the great medical encyclopedia of a 
country so renowned for its medical talent. 

All of the nosographers so far mentioned have 
enumerated only a very few of the affections of 
the uro-genital apparatus. 

A number of other nosographies which have 
more or less merit are noticed under the head of 
bibliography. 



170 



WILLIAMS. 



As pertinent to the subject, Doctor Williams' 
tabular arrangement of structural diseases or 
diseases of nutritition is here reproduced from 
the American edition of his work published in 
the year 1853.* 






D 

*«! 
'O 
1) 

a 



Increased. — Hypertrophy 
Diminished. — Atrophy 
f Induration 
Softening 
Transformation 






r Contraction 
Dilatation 
Obstruction 
Compression 
Displacement 
Rupture, etc. 



Euplastic 



Cicatrices 

False membranes 



f Cirrhosis 
~ , x . \ Fibro-cartilage 
Cac °P lastlc 1 Gray tubercle 

[ Atheroma, etc. 



Aplastic 



Non- 
malignant 



o 1 



Yellow tubercle 
Calareous matter, 

etc. 
Cysts 
Tumors 
Hydatids, etc. 



S Carcinoma 
Encephaloma 
Melanosis, etc. 



* Principles of medicine, etc., by Charles J. B. Williams, 
M. D„ F. R. S. etc. American edition by Meredith Clymer, 
M. D., Philadelphia 1853. The American editor has contrib- 
uted much to exact nomenclature, particularly in his writings 
of the last twenty years. 



AITKEN 171 

ON THE PRINCIPLES OF CLASSIFICATIOxV. 

Sir William Aitken, in his " Science and 
Practice of Medicine," third edition, published 
in London in the year 1864, under the head 
11 Principles of Classification," says : 

" Many systems of nosology have been adopted 
from time to time ; and as valuable general prin- 
ciples have been adduced from some, the grounds 
on which diseases have been classified may be 
briefly described under the following nine heads : 

" I. The nature of the ascertained causes of 
disease. On this principle two classes of dis- 
eases are recognised : (1,) Diseases arising from 
general causes ; (2,) Diseases arising from specific 
causes. 

" II. The pathological states and conditions 
which attend diseases. The principle of this 
classification consists in determining alterations 
of the structure or the chemical composition of 
parts, from which names are given to the dis- 
ease 

" III. The properties, powers, or functions of 
an organ or system of organs being deranged, 
dictates a classification in which the most prom- 
inent effects or phenomena of morbid states are 
considered as the disease 

" IV. The diseases comprehended under the 



172 AITKEN. 

two latter principles of classification are some- 
times inaccurately and loosely brought together 
under the heads of structural and functional dis- 
eases. The diseases of function, for instance, be- 
ing made to embrace the neuroses, haemorrhages, 
and dropsies ; while inflammation, tubercle, can- 
cer, melanosis, hypertrophy and atrophy are the 
subordinate classes of the diseases of structure. 

" V. A basis of classification has been adopted, 
founded on the pathological nature of the dif- 
ferent morbid processes, but the arrangement of 
the orders and subdivisions is determined by the 
anatomical arrangement of the textures and or- 
gans of the animal body, as originally developed 
by Bichat. 

" VI. A ground of classification exists, having 
reference to the general nature and localisation 
of the morbid states. It comprehends three 
classes: (i,) Diseases which occupy the whole 
system at the same time, and in which all the 
functions are simultaneously deranged. These 
have been named general diseases, such as fevers ; 
(2,) Constitutional affections, meaning thereby 
diseases which display themselves in local lesions 
in any part but not in all parts at the same time — 
e.g., rheumatism, gout ; (3,) Local morbid pro- 
cesses. 

" VII. Applying the principles of a purely 



SAVIGNAC, STARK. 1 73 

humoral pathology, we have a classification con- 
sisting of — a. Fevers ; b. Dyscrasiae — e. g., tabes, 
chlorosis, scorbutus, dropsy, diabetes, pyaemia, 
tuberculosis, carcinoma ; c. Constitutional dis- 
eases, induced by, — (i,) specific agents, (2,) veget- 
able substances. 

" Such is Wunderlich's arrangement of dis- 
eases (1852). 

" VIII. Mr. de Savignac, Professor of Clinical 
Medicine at the Naval School of Toulon, has re- 
cently (1861) propounded a nosological arrange- 
ment (which he considers a natural one) founded 
on what he believes to be the ■ elements ' of dis- 
ease. His so called elements seem to be vague 
general expressions, or names to denote the lead- 
ing phenomena of diseases or the unknown cause 
of such phenomena 

" IX. Doctor Stark, of Edinburgh, has recently 
(1864) proposed an arrangement embracing six- 
teen classes: (1,) Fevers; (2,) Diseases of the 
brain, etc. ; (3,) Diseases of the heart and organs 
of circulation ; (4,) Diseases of the organs of 
respiration ; (5,) Diseases of the organs of diges- 
tion ; (6,) Diseases of the urinary organs ; (7,) 
Diseases of the organs of generation ; (8,) Dis- 
eases of the organs of locomotion ; (9,) Diseases 
of the skin and cellular tissue ; (10,) Diseases of 
uncertain seat ; (1 1,) Malformation ; (12,) Debility 



174 STARK, FARR. 

at birth, and premature birth; (13,) Old age; 
(14,) Sudden deaths; (15,) Violent or unnatural 
deaths ; (16,) Causes not specified 

" Classification conducted on the plan 

proposed by Doctor Stark is inconsistent with 
any intelligible principle of arrangement. 

" None of these nine principles of classification 
lead to a perfectly philosophical or purely nat- 
ural classification, because diseases are not yet 
sufficiently understood to permit us to see clearly 
their mutual relations ; and the best recommend- 
ation of any one of them would be a negative 
one — namely, that of doing the least possible vio- 
lence to our imperfect knowledge regarding the 
natural affinities or alliances of diseases, of which 
we have at present only a sort of instinctive 
recognition " 



The svstem adopted by Sir W. Aitken in 
nearly all the editions of his work is that of 
Doctor William Farr, and consists of five classes 
as follows: (1,) Zymotic diseases, four orders; 
(2,) Constitional diseases, two orders ; (3,) Local 
diseases, eleven orders ; (4,) Developmental dis- 
eases, four orders ; (5,) Lesions from violence 
tending to sudden death, six orders. In all 
twenty-seven orders. 

Doctor Farr's system, says Sir W. Aitken, 
was discussed at several meetings of the statist- 



ROYAL COLLEGE OF PHYSICIANS. 1 75 

ical congress of the European nations, in Paris 
(1855), an d in Vienna (1857), where a nomen- 
clature similar to the English was adopted, but 
no definite classification was agreed upon. 

LABORS OF THE ROYAL COLLEGE OF 
PHYSICIANS OF LONDON. 

A joint committee, of which Doctor William 
Farr was a member, appointed by the Royal 
College of Physicians of London to draw up a 
nomenclature of diseases, published its first re- 
port in the year 1869, after more than ten years 
of labor. In this report, one thousand one hun- 
dred and forty-six diseases are enumerated, ex- 
clusive of human parasites of which fifty-five are 
counted. The committee very properly offered 
this nomenclature as only provisional and sug- 
gested that it be subjected to decennial revisions. 
The main object of the work, as set forth in the 
preface, was to lay "the foundation for a nomen- 
clature of diseases in any language extant on the 
earth." 

This nomenclature has been reprinted by 
order of the chief of the United States Marine 
Hospital Service, in 1874, and a few years ago a 
part of the first decennial revision was printed by 
order of the New York State Board of Health. 



176 AMERICAN MEDICAL ASSOCIATION. 

In the year 1869 the American Medical Asso- 
ciation appointed a committee "to determine 
what alterations, if any, are necessary, to adapt 
the Provisional Nomenclature of the Royal Col- 
lege of Physicians of London to general use in 
the United States." This Committee reported, 
in 1870, " that the English nomenclature was not 
adapted to this end, and recommended the ap- 
pointment of a new committee to prepare a 
nomenclature of their own." The new commit- 
tee was appointed with Dr. Francis Gurney 
Smith, as Chairman and, in 1872, presented its 
report and nomenclature, based upon the English 
system. A minority report was then submitted to 
the Association. Both reports were accepted, but 
only the following resolution, appended to the 
minority report was adopted. 

" Resolved, That the Nomenclature and classi- 
fication just submitted by the committee be pub- 
lished in the Transactions ; that one thousand 
extra copies be printed in pamphlet form and 
distributed to the profession, and that the ques- 
tion of the adoption of the proposed Nomencla- 
ture and classification by this body be postponed 
till the next annual meeting." 

The extra copies of the nomenclature were dis- 
tributed in accordance with the resolution offered 
by the minority of the committee, and at the 



ROYAL COLLEGE OF PHYSICIANS. 1 77 

next annual meeting (1873) °f the Association a 
majority report was again presented. But it 
was urged that the American nomenclature was 
inferior to the English and after some discussion, 
the following resolutions were adopted. 

" Resolved, That in the opinion of this Asso- 
ciation, it is inexpedient to adopt the nomencla- 
ture and classification presented by the majority 
of the committee on nomenclature at the meeting 
in Philadelphia." 

11 Resolved, That a committee of three be ap- 
pointed by the President, whose duty it shall be 
to communicate the foregoing resolution to the 
proper committee of the Royal College of 
Physicians of London, and to negotiate for the 
representation of the American Medical Associa- 
tion in the first decennnial revision of their 
nomenclature." 

The committee was duly appointed, but has 
never made any report. 

In the second edition of the official nomencla- 
ture of the Royal College of Physicians of Lon- 
don (1885), it seems as though the committee had 
failed to take advantage of many of the medical 
advances of the decade, for, aside from the viola- 
tions of established principles of nomenclature 
and classification which it contains, much of the 



178 THE DERMATOLOGISTS. 

old medical terminology is retained, and many 
symptoms are still classed as diseases. 

It is t needless to indulge in any extended crit- 
icism of this new nomenclature, since it has al- 
ready been so fairly and exhaustively reviewed. 
The reader is therefore referred to the excellent 
critical analysis of the London nomenclature by 
Doctor A. Rabagliati, of Bradford, England. 
This review, which is well worthy of the most 
careful study, first appeared in the " Medical 
Press and Circular," and then in book form.* 

The dermatologists have contributed largely 
to systematic arrangement for a century past. 
Their bibliography begins with the nomenclature 
of Celsus, of Mercurialis (1572), and of Riolan 
(1610), from which they trace their systematic ar- 
rangement of dermatoses down to Auspitz f 
(1881) and Bronson J (1884 and 1887). Their 



* Some remarks on the classification and nomenclature of 
diseases, by A. Rabagliati, M. A., M. D., reprinted from the 
Medical Press and Circular. — London, Bailliere, Tyndall, and 
Cox, 1886. 

t For a very extended dermatographical bibliography, and 
synopsis of divers systems, see Auspitz' system der Haut- 
krankheiten, Vienna 1881. 

X E. B. Bronson. The objects of dermatological classifica- 
tion, with especial reference to Auspitz' system. Journal of 
cutaneous and venereal diseases. Vol. II, June 1884. 



THE DERMATOLOGISTS. 1 79 

work however requires a very extensive revision, 
if not an entire reconstruction. 

The preceding outline of the history of noso. 
graphy, and of the synopses of a few of the old 
systems, is here given with the view of placing 
the reader in possession of the methods of the 
nosographers in a compact form, in order that he 
may see almost at a glance the defects of the early 
essays and compare them with the modern sys- 
tems before he contributes his share to the im- 
provement of this science. 

A few of the nosographers, to whose labors 
allusion has been made in the historical outline 
have worked with great fidelity and earnestness 
for the improvement of this science, while the 
great majority have simply copied their prede- 
cessors and reproduced their most obvious errors 
without the least attempt at correction. 

Some of the rules formulated by the early writ- 
ers are appended to this history. 



E. B. Bronson. A study of the considerations relating to 
the classification of skin diseases with an attempt to construct 
a logical system in accordance with fundamental principles of 
etiology. Pamphlet, pp. 19. Reprinted from the Journal of 
cutaneous and genito-urinary diseases. October 1887. 



i8o 

RULES FOR THE GUIDANCE OF THE 
NOSOGRAPHER. 

The following rules, for the guidance of noso- 
graphers, laid down by Cullen, Parr, Linnaeus 
and Young, are given in full because of their 
general excellence and because they illustrate so 
well the principles of nomenclature and classi- 
fication, besides carrying with them the authori- 
tative weight of these eminent men who labored 
with so much ardor for the advancement of noso- 
graphy. 

Cullen's nosography appeared in the year 1769. 
He therefore had the benefit of the experience 
of Sauvages, Linnaeus and Vogel. He endeav- 
ored to improve upon them, and formulated cer- 
tain rules for distinguishing genera, species, and 
varieties. These rules are here reproduced, al- 
though some of them do not now possess the 
value which they may have had at the time of 
their publication.* 

cullen's rules for distinguishing 
genera, species and varieties. 

i. " Those who have turned their attention to 
this subject hitherto, have not I think proceeded 
with due consideration. They have gone at once 



Edinburgh edition 1800. 



cullen's rules. 181 

to constitute the principal genera of the classes 
and orders, without sufficiently attending to the 
species of diseases. Now nature has made noth- 
ing but species ; the structure of genera is an ef- 
fort of the human mind, which, till the species 
are well known and understood, must be falla- 
cious and uncertain ; and indeed, in constituting 
genera, unless we have perpetual reference to 
the species, all our labor will prove futile and 
vain. 

2. " It is certainly a very difficult thing in 
nosology to say what is a true species, or what is 
only a variety ; as those marks which serve to 
distinguish species from varieties in zoology and 
botany, are not to be found in diseases. I there- 
fore considered it as safest and even necessary to 
enumerate many varieties. And as I esteem such 
a distinction very useful in practice, I have every- 
where endeavored to make it : not always indeed 
with equal certainty, but often, at least, with 
some degree of probability. 

3. " When any disease, under which several 
men labour, exhibits, in each individual, all the 
symptoms that characterise a certain species, I 
would not consider that these were different 
species, because the symptoms prevailed in one 
patient in a greater or less degree, than in an- 



182 cullen's rules. 

other. And I am of opinion that diseases which 
differ only in a degree, constitute merely varieties 
of a certain species. 

4. " Accordingly in distinguishing a variety 
from a species, there is only room for doubt 
when, in the diseases of different persons, any 
symptoms are wanting which generally accom- 
pany a species, or when others are present. 

5. " When any of the usual symptoms are 
wanting ; and we can distinguish between those 
that are more and those that are less essential, 1 
consider the absence of such symptoms as indica- 
tive of a variety only. 

6. " When to the characteristic symptoms, 
others are added, which can be reckoned the 
symptoms of symptoms, rather than the symp- 
toms of the cause, they constitute only a variety. 

7. " Again, when these additional symptoms 
are quite unusual, while, at the same time, the 
principal circumstances of the disease are little 
or not at all changed ; these too afford only a 
variety. 

8. " When any genus of disease may arise from 
different causes, the diversity of the cause may 
occasion likewise diversity in the species, though 
not always ; for when the difference is small, and 
the symptoms at the same time are little affected 



cullen's rules. 183 

by it, that difference will constitute only a 
variety. 

9. " A genus of disease may, in the same man- 
ner, produce different species, according to the 
diversity of its seat; but as often as the seat is 
different, while there is no difference either with 
respect to the structure of the part or its func- 
tions, this diversity of seat can only indicate a 
variety." 

In the edition of 1827, Cullen remarks, that in 
nosology, by beginning with the characters of the 
class, and from thence descending to orders and 
genera, the term genus has been very universally 
applied to species, and that, by imitation, he had 
been led to do the same thing, for, of the one hun- 
dred and thirty three genera which he had estab- 
lished in his first edition, a hundred are properly 
species, and admit of no farther division except 
into varieties. He further said, " the characters 
of diseases are formed by a concourse of various 
symptoms, every particular of which, in the 
language of methodical writers, is a nota or 
mark: now, in forming the character, the first, 
and the most important rule is, that these marks 
should be neither more nor fewer than are ab- 
solutely necessary. If we have more, we pass 
from characters or definitions to descriptions ; 



1 84 cullen's rules. 

we leave persons in doubt when they find a dis- 
ease with the strictly essential character, by add- 
ing other circumstances which they may suppose 
to be equally necessary. The nosologists have 
been faulty in giving both superfluous and de- 
ficient characters. 

" A second rule is, that the marks which we 
-employ should be sufficiently evident, and if pos- 
sible, constantly present at every period of the 
disease, these at least (that) are the most charac- 
teristic. Nosologists transgress against this rule 
when the marks are taken from the duration, 
and much more from the event of the disease. 
To affirm that a disease is a fatal one, is indeed a 
part of its history, but cannot serve as a charac- 
ter when we first view the disease. 

" The third rule is, that the notae chosen 
should be expressed in clear and very intelligible 
terms, and, if possible, in terms the meaning of 

which is already fixed in science The 

want of due precision of language affects many 
parts of all our systems. It is well known, that 
the want of precision in the use of terms for a 
long time retarded the perfection of botany ; and 
it has been the greatest merit of Linnaeus, that 
lie gave much more precision, and a determined 
meaning to almost every word employed in that 



parr's rules. 185 

science, which he did by forming a dclincato 
plantae, by fixing a term for every part of a 
plant, and for all the circumstances in which 
these parts can vary. But we will not bring 
nosology to a good condition till something of 
the same kind, a dclineatio morbi, be attempted, 
which ought to consider all the symptoms that 
enter into a specific character in another view 
than that taken by the pathologists, who only 
trace them to their causes. Here we ought to 
examine the symptoms more minutely with re- 
spect to the variety of their appearance, and affix 
terms to them accordingly. 

" The fourth rule, is that the characters should 
be absolutely free and independent from all 

theory and hypothesis Every species 

ought to have the character of its genus; and in 
naming or distinguishing species, it is sup- 
posed sufficient merely to name the genus, and 
to add such marks as distinguish the species." 

parr's rules. 

Under the head of classification Dr. Parr says : 
1. "It is said that nature has created only 
species : it is not true ; for she has created only 
individuals. The similarity of these has occa- 
sioned the establishment of species. Individuals, 



1 86 parr's rules. 

differing in circumstances arising from accident ; 
in plants and animals, from soil and climate ; in 
diseases, from constitution ; in minerals, from lo- 
cality, are styled varieties ; and these, when cir- 
cumstances are changed, return to the species 
from which they started. These distinctions, 
though apparently simple and obvious, are how- 
ever, necessary ; for naturalists have usually be- 
gun at the other extremity, and formed ' meth- 
ods,' classes, and orders before they have estab- 
lished species and, at this moment, in nosology 
and mineralogy, the greatest impediments to im- 
provement arise from the uncertainty of what 
are species. Even in botany this difficulty was 
once so great, that more than half of Tourne- 
fort's supposed species have been found to be 
varieties only. Three-fourths of Sauvages' species 

of diseases are varieties or symptoms.* 

2. " This is the first step in arrangement ; for 
the establishment of species consists in ascertain- 
ing identity ; of genera similarity. A striking 
discriminating mark, in many species, sometimes 



* The criticism made, by Dr. Parr of Sauvages' species of 
diseases, three quarters of a century ago, will apply, to a very- 
great extent, to the two editions of the modern English 
nomenclature, for they both include many symptoms classed 
as diseases. 



parr's rules. 187 

establishes a genus ; at others, a general similar- 
ity. The conduct of botanists, however, has dif- 
fered in this part of their labor, from the differ- 
ence of their dispositions. Some naturalists, 
catching hastily at analogies, have included nu- 
merous species under a genus : others more wary 
and exact, have retrenched them too rigorously. 
The latest botanists have rendered the genera 
more, sometimes too, numerous ; but this of the 
two is the more venial error, since new dis- 
coveries continually enlarge them. 

3. " An order is an association of genera ; but 
orders are usually too comprehensive, including" 
too great a number of genera ; and to facilitate 
investigation, these are often divided into sepa- 
rate groups, as in mineralogy the species are 
sometimes divided into sub-species. Each is a 
proof of imperfection in arrangement. 

4. "A class contains the different orders; and 
though in reality, it should be the last, or nearly 
the last, labourer, it has usually been the first ; 
and to make the system elegant in appearance, 
the classes have been few and comprehensive." 






i88 

APHORISMS RELATING TO CLASSIFICATION, 
TAKEN CHIEFLY FROM THE 
PHILOSOPHIA BOTANICA OF LINNAEUS, 
BY DOCTOR THOMAS YOUNG. 

Of generic characters. 

i. " The foundation of methodical science con- 
sists of two parts, arrangement and nomenclature. 

2. "Arrangement is either theoretical, relating 
to classes, orders, and genera, or practical, relat- 
ing to species and varieties. 

3. " Arrangement or method is either synop- 
tical or systematic. 

4. " A synopsis depends on arbitrary divisions 
proceeding in pairs at each step, and is not ad- 
missible in botany, except as a key or index. 

5. " A system proceeds in its arrangement by 
five steps ; classes, orders, genera, species, and 
varieties. 

6. " System is the Ariadnean thread, without 
which all is confusion. 

7. 4< Species in natural history are supposed to 
have been originally created distinct. 

8. " Varieties may be as numerous as the in- 
dividuals which have been produced. 

9. " Genera are determined in botany from the 
agreement of the parts of fructification. 



LINNAEUS AND YOUNG. 1 89 

10. " Classes are deduced from the regular 
agreement of many genera, in the parts which 
characterise them. 

11. "An order is a subdivision of a class, in- 
tended for convenience. 

12. "Species and genera depend on nature; 
varieties often on cultivation ; classes and orders 
on a combination of nature and art. 

13. "Habit is a general agreement in growth 
and appearance. 

14. " Habit is to be silently consulted in form- 
ing genera, but must not and cannot be de- 
scribed. 

15. "No positive rules can be laid down re- 
specting identity of genus. 

16. " Few genera are without some cases of 
accidental deviation. 

17. " Each genus is commonly characterised by 
some decided singularity of form. 

18. "Genera thus marked must be kept dis- 
tinct or united accordingly. 

19. " The more constant the mark in different 
species, the better distinction it affords. 

20. " Different parts are the most constant in 
different genera ; but scarcely any part is ever 
wholly invariable. 



igO APHORISMS OF LINNAEUS 

21. "A generic character is the definition of a 
genus, and may be of three kinds, factitious, es- 
sential, or natural. 

22. " An essential character affords a singular 
and appropriate criterion of the genus. Its ex- 
cellence depends on its brevity. 

23. " A factitious character distinguishes the 
genus only from others of the same artificial 
order. 

24. " A natural character contains everything 
remarkable that is found in all the species of the 
genus. It may often require alteration when new- 
species are discovered. 

25. " A factitious character is a substitute for 
an essential one, which is always the best when 
it can be obtained. A natural character is a work 
of great labor, but, when completed, it is the 
basis of all systems, the guardian of genera, and 
is applicable to every correct and practicable 
mode of arrangement. 

26. "No character can be infallible unless it 
has been compared with all the species of the 
genus. 

27. " A generic character must not contain 
comparisons, except with things perfectly well 
known. 

28. " The character must be expressed in se- 



AND YOUNG. 191 

lect, accurate, distinct, and compendious terms, 
sufficient in number, but not superfluous. 

29. " The character must remain invariable in 
every possible system that can be adopted. With 
this precaution, the introduction of a new system 
is no misfortune. 

30. " A genus may consist of a single species, 
although it more usually contains several species. 

31. " What is established respecting the charac- 
ters of genera must be understood, with some 
latitude, of those of classes. 

32. " Classes are more arbitrary than genera, 
orders than either. 

33. " The more naturally classes are established 
the better. 

34. " Great difficulty arises from the excessive 
length or number of classes and orders. 

35. "Genera which are allied to each other 
ought to stand together. 

Of names. 

36. " He who establishes a new genus is bound 
also to give it a name. 

37. " A generic name must be decided on be- 
fore a specific one is formed. 



I92 APHORISMS OF LINNEAUS 

38. "No man in his senses would employ a 
generic name destitute of etymological meaning. 

39. " Generic names consisting of two entire 
and separate words are prohibited. 

40. " Generic names consisting of two Latin 
words united together are scarcely to be tol- 
erated. Such compounds of Greek origin, on 
the contrary, are elegant. 

41. " Generic names of hybrid origin, for in- 
stance partly Greek and partly Latin, are to be 
rejected. 

42. " Generic names including other generic 
names are unworthy of a scientific nomenclature. 

43. " Generic names ending in oides are pro- 
hibited. 

44. " Generic names derived from others by 
the addition of a syllable are disapproved. 

45. "Generic names very nearly resembling 
each other are likely to cause confusion. 

46. " Generic names not derived from Greek 
or Latin are forbidden. 

47. " Generic names common to natural history 
and anatomy, pathology, therapeutics, or the 
arts, are to be avoided. (Thus lichen must not 
be a genus of diseases : and I have been obliged 
to change the name spiloma into spilosis, having 



AND YOUNG. 193 

found that the botanists had taken possession of 
this too.) 

48. " Generic names contradicting the proper- 
ties of some of the species are bad. 

49. " Generic names must not be identified with 
those of natural classes or orders. 

50. " Diminutives and derivatives of a similar 
nature are allowable as generic names. (The 
diminutives of other generic names are however 
scarcely admissible.) 

51. " Adjectives are inferior to substantives as 
generic names. 

52. " Generic names which have already been 
employed are to be preferred where it can be 
done without inconvenience. (Sometimes how- 
ever it is better to employ a new term than to 
alter materially the application of an old one.) 

53. " Such generic names as express an essen- 
tial character or habit are the best. 

54. "An ancient name should be employed for 
a genus long established. 

55. "A good name once established ought not 
to be changed, even for a better or more ancient 
one. 

56. " If a genus is to be divided, the old name 



194 APHORISMS OF LINNAEUS 

must remain attached to the most common 
species. 

57. " Generic names are to be written in Latin 
letters, the Greek letters being expressed accord- 
ing to the established custom. 

58. " The sounds of generic names are to be 
softened as much as possible. 

59. " Long and harsh names are to be avoided. 
Names should scarcely exceed twelve letters. 

60. " Terms of art ought not to be employed 
for generic names. 

61. " Names of classes and orders are to be 
governed by the same rules as those of genera. 
The name. is to be single ; not unmeaning, hybrid, 
barbarous, equivocal, inapposite, personal, too 
long, nor harsh. 

62. " Names of classes and orders should in- 
clude their characteristic marks. 

Of specific differences. 

63. " A perfect name includes a generic and a 
specific name. All solid learning in natural his- 
tory, agriculture, and medicine, depends on the 
knowledge of species. 

64. "A legitimate specific name or character 
distinguishes the species from all others of the 



AND YOUNG. I95 

same genus. Trivial names, often called specific 
names, are subjected to no very accurate rules. 

65. " All specific characters which distinguish 
the species from others, not of the same genus, 
arc superfluous and bad. 

66. " Trivial names are only limited to a single 
word. (Substantives have an advantage over ad. 
jectives, as being more convenient when brevity 
is required ) 

6y. " Specific characters must be taken from 
circumstances not subject to vary. 

68. " Magnitude affords no specific distinction. 
(Thus the degree of putrescency scarcely affords 
a sufficient distinction between nervous and pu- 
trid fever.) 

69. " Comparisons with other genera are to be 
excluded from specific characters. 

70. " Comparisons with other species of the 
same genus are bad. 

71. " Care must be taken to exclude varieties 
from the rank of species. 

72. " Each species must bear the name of the 
genus. 

73. " The specific name must always follow the 
generic. The idea of the genus must occur first 
to the mind. 



I96 APHORISMS OF LINNAEUS 

74. " A specific name without the generic is 
like a bell without a clapper. 

75. " The specific name must not be united to 
the generic as a termination. 

76. "A genuine specific character is either 
synoptic or essential. 

77. " A synoptic specific character distinguishes 
the species of the genus by successive subdivi- 
sions into two portions. In large genera such 
subdivisions are often indispensable. 

78. " An essential specific character exhibits a 
single distinction, appropriate to one species 
only. 

79. " The shorter a specific character can be 
made, the better, provided that it be sufficient. 

80. " Specific characters must contain only 
such words as are necessary for distinguishing 
the species from others of the same genus. 

81. " When a genus contains only one species, 
a specific character is superfluous. (There may 
however be cases in which a character, pointed 
out as likely to be essential, by a person well 
acquainted with the species, may be useful in dis- 
tinguishing it from others subsequently dis- 
covered.) 

82. " When a new species of a genus is dis- 



AND YOUNG. 1 97 

covered, the characters of all the other species 
must be accommodated to it, if they become in- 
adequate. 

83. " The words forming a specific character 
are not to be compounds resembling generic 
names, nor purely Greek, but Latin ; and the 
more simple they are, the better. 

84. " The specific character ought not to be 
embellished by the flowers of rhetoric, but natu- 
ral and faithful. 

85. " The specific character admits neither 
comparatives nor superlatives. 

86. " The specific character must be expressed 
in positive terms, not negative. (Privatives are 
often unavoidable, although in some measure 
objectionable ) 

87. " Resemblances, if ever employed for spe- 
cific characters, must be striking and well known. 

88. " Adjectives must immediately follow their 
substantives. 

89. " Conjunctive particles are to be excluded 
from specific characters, except where they are 
necessary to the sense. 

90. " Successive adjeciives are not to be sep- 
arated by commas. 

91. " A specific character must never contain 



I98 APHORISMS OF LINNAEUS 

a parenthesis, whether distinguished or not by 
the appropriate mark. A parenthesis is bad, as 
implying a defect of order. 

Of varieties. 

92. " To the generic name and specific charac- 
ter the distinction of a variety may be added, 
where it exists. 

93. " The generic names, the specific character, 
and the marks of varieties, are to be printed in 
different types. 

94. " Very slight varieties are to be disre- 
garded. 

95. "The specific character must agree with 
all the varieties, as far as is practicable. 

96. " It is often as difficult and as important to 
reduce varieties to their proper species, as 
species to their proper genus. 

Of Synonyms, 

97. " Among the synonyms enumerated, the 
most approved name is to be set down first. 

98. " Authors who have employed the same 
synonyms are to be quoted together. 

99. " Each synonym is to begin a new line. 



AND YOUNG. 1 99 

100 " Synonyms must be accompanied by 
the names of the authors, and the pages of the 
works in which they are to be found." 

The student of nosography may, with profit, 
consult the modern system of " Laws of Botanical 
Nomenclature" which was adopted by the Inter- 
national Botanical Congress held at Paris in 
August, 1867, and which was published together 
with a historical introduction and a commentary 
by Alphonse De Candolle. 



* 



200 BIBLIOGRAPHY. 



SECTION III. 

NOSOGRAPHICAL BIBLIOGRAPHY. 

A chronological list of the works on nosography that have 
appeared from the time of Felix Platerus to the present. 

Platerus, (Felix)— Praxeos Medicae, etc. Bas- 

iliae, 1602. 
Warenius, (Henricus) — Nosologia. Leipsiae, 

1605. 
Petraeus, (Henricus) — Nosologia Harmonica, 

Dogmatica, et Hermetica. Mar- 

burgi, 1614. 
Junius, (Adrianus) — Nomenclator. Francofurti, 

1620. 

Johnstonus, (J.)— Idea Universalis Medicinae. 
Amsteldami, 1644. 

Schoenfeld, (Phillipus Jacobus) — Nosologia. 
Ingolstadii, 1675. 

Sauvages, (Francois Boissier de) — Nouvelles 
classes des Maladies Disposees dans 
un Ordre Semblable a celui des 
Botanistes, Comprenant les Genres 
et les especes. Montpellier, 1732. 



BIBLIOGRAPHY. 201 

Sauvages, (F. B. de)— Nosologia Methodica. 
Lugduni, 1760. Geneva, 1763. 

Hebenstreit, (Johannes Ernestus) — Program- 
mata, Ordo Morborum Causalis. 
Leipsiae, 1754— 1757. 

Hebenstreit, (J. E.) — Exegesis nominum grae- 
corum, quae morbos definiunt. Lip- 
siae, 1751 — 1761. 

Linnaeus, (Carolus) — Genera morborum. Up- 
salae, 1759— 1763. 

Vogel, (Rudolphus Augustus) — Dissertatio, Def- 
initionesGenerum Morborum. Goet- 
ingae, 1764. 

Plenk, (J. J.) — Novum Systema Tumorum qui 
hi morbi in sua genera et species 
rediguntur. Vienna, 1767. 

Cullenus, (Guiliemus) — Synopsis Nosologiae 
Methodicae in Usum Studiosorum. 
Edin., 1769, — 1772, — 1780. 

CULLEN, (William) — A synopsis of Methodical 
Nosology, etc., translated, from the 
fourth edition, by Henry Wilkins, 
M. D. Philadelphia, 1793. 

CULLEN, (W.) — Nosology, etc., translated from 
the Latin. Edin., 1800. 



202 BIBLIOGRAPHY. 

Cullenus, (G.) — Synopsis nosologiae meth- 
odicae, etc., editio sexta, 1803. 

Cullen, (W.)— The works of, edited by John 
Thomson, M. D., etc. Edin., 1827. 

Sagar, (J. B. M.) — Systema morborum symp- 
tomaticorum secundum classes, or- 
dines, et genera, cum characteribus. 
Vienna, 1771. Editio tertia, 1783. 

Macbride, (David) — A Methodical Introduction 
to the Theory and Practice of 
Physic. London, 1772. 

Selle, (Christ. T.) — Rudimenta Pyretologiae 
Methodicae. Berlin, 1773. 

Ackermann, (J. F.) — Programma sistens nosolo- 
giam Holsaticam. Kiloniae, 1773. 

Hartung, ( ) — Diss, de generali mor- 

borum divisione. Aug. Trev., 1777. 

Hennemann, (Guil. Josephus) — Primae lineae 
nosologiae animalium. Goettingae, 
1778. 

Vitet, (Louis) — Medecine expectante. Lyons, 
1778. (Containing a nosological 
method.) 

Haartmann, (J. J.) — Diss. Sciagraphiae mor- 
borum. Aboae,fi779. 



BIBLIOGRAPHY. 2 03 

Cirillio, (D.) — Nosologiae Methodicae Rudi- 

menta. Napoles, 1780. 
Tode, (J. C.) Copenhagen, 1781. 

Daniel, (Chris. Fredericus) — Systema aegritu- 

dinum. Leipsiae, 1781. 
Gieseke, ( ) — Animadversiones in systema 

nosologicum. Goettingae, 1781. 
VACHIER, ( ) — " Methode nosologique." 

Paris, 1785. 

Wallis, (George) — Nosologia methodica ocu- 
lorum ; or a treatise on diseases of 
the eyes ; selected and translated 
from the Latin of Francis Boissier 
de Sauvages, with annotations. 
London, 1785. 

Van Heuvell, ( ) — Tentamen nosolog- 

icum, sistens morborum a vitio vis 
vitalis divisionem et dispositionem 
practicam. Lugduni Batav., 1787. 

Sprengel, (Curtius) — Rudimentorum nosologiae 
dynamicorum prolegomena. Hallae, 
1787. 

Baldinger, (E.G.) — Opuscula Medica, containing 
among other dissertations, animad- 
versionum in systema nosologiae, 
specimina 1 et II. Goettingae, 1787-8. 



204 BIBLIOGRAPHY. 

Lauth, (Thomas) — Nosologia chirurgica. Ar- 

gentorati, 1788. 
Ploucquet, (Guil. Godofredus) — Delineatio sys- 
tematis nosologici naturae accomo- 
dati. Tubingae, 1791. 
Ploucquet, (G. G.) — Onomatopoeae nosologiae 

fundamenta. Tubingae, 1793. 
Dyrsen, ( ) — Diss, primae lineae systematis 

morborum aetiologici. Goettingae, 
1792. 
Arnemann, (Justus) — Synopsis Nosologiae. 

Goettingae, 1793. 
Assur, ( ) — Diss. Animadversiones ad sys- 

tema nosologica usitatiora. Regio- 
montis, 1794. 
Darwin, (Erasmus) — Zoonomia. London, 1794 — 

1796. 
Grunner, (Chris. Gottfr.) — Nosologia Historica. 

Ienae, 1795. 
MUNCK, ( ) — Diss, sistens nonnulas circa 

nosologiam methodicam observa- 
tiones. Lundini, 1796. 
CAILLAU, (Jean Marie) — Premieres lignes de 
nosologic enfantine. Bordeaux, 1797. 
PlNEL, (Philip) — Nosographie philosophique. 
Paris, 1798— 1 818. 



BIBLIOGRAPHY. 205 

Castel, (Louis) — Analyse critique et impartiale 
de la nosographie philosophique de 
Pinel. Paris, An VII. 

Hoffmann, (Philip) — Grundriss eines systems 
der Nosologic und Therapie. Elber- 
feld, 1798. 

Callisen, (H.) — Systema Chirurgiae Hodiernae. 
Containing a classification of sur- 
gical diseases. Copenhagen, 1798. 

Nebel, (E. L. VV.) — Specimen nosologiae bru- 
torum cum hominum morbis com- 
paratae. Giessae, 1798. 

VlLLARS, (de Grenoble) — Tableau nosographique 
servant d'introduction a la con- 
naissance des maladies internes et 
externes, 179S. 

Willan, (Robert) — Description and Treatment 
of cutaneous diseases. London, 
1798 — 1807. 

Brera, (Valeriano Luigi) — Classificazione delle 
malatie secondo i principi di Brown, 
si premette una definizione dei vo- 
caboli propri del sistema Brovvniano. 
Venet, 1799. 

Horn, (Ernst) — Versuch einer praktischen noso- 
logic der fieber. Brunsvic, 1800. 



206 BIBLIOGRAPHY. 

Baumes, (J. B. Th.) — Fondemens de la science 
methodique des maladies. Mont- 
pellier, 1801. 

Baumes, (J. B. Th.)— Essai d'un systeme 
chimique de la science de l'homme. 
Nismes. an VI. 

Meyer, ( ) — Diss, integram et systematicam 

morborum divisionem dari non 
posse una cum nonnullis observa- 
tionibus de principio nosologiae 
Reschlaubianae subjecto. Franco- 
furti ad Viadrum, 1801. 

Tourdes, (J.) — Esquisse d'un systeme de noso- 
logic, fonde sur la physiologie et la 
therapeutique. Strasbourg, 1802. 

Bayle, (G. L.) — Considerations sur la nosologic, 
la medecine d'observation, et la 
medecine pratique, suivies d'observa- 
tions pour servir a l'histoire des 
pustules gangreneuses. Paris, 1802. 

Abernethy, (John) — Surgical observations, con- 
taining a classification of tumors, 
etc. London, 1804. 



BIBLIOGRAPHY. 207 

Abernethy, (J.) — " An attempt to form a classi- 
fication of tumors according to their 
anatomical structure." In the Sur- 
gical works of John Abernethy, 
F. R. S. From the sixth London edi- 
tion. Hartford, Connecticut, 1825. 

Crichton, (Alex.)— A synoptical table of dis- 
eases, exhibiting their arrangement 
in classes, orders, genera, and spe- 
cies. London, 1804. 

TOURTELLE, (E.) — Elemens de medecine theorique 
et pratique. 1805. 

Salva, (D. F.) — Discorso sobre la necesidad de 
reformar los nombres de los morbos, 
y plan para hacerlo. Barcelona, 1807. 

Parr, (Bartholomew) — The London Medical 
Dictionary. 1809. Article nosology. 

Swediaur, F. (181 2.) — In Hosack's system of 
Nosology. 

Young, (Thomas) — An introduction to medical 
literature, including a system of 
practical nosology. London, 18 13. 

Davidge, (J. B.) — Nosologia methodica: classium 
et generum, et specierum, et varieta- 
tum series morborum exhibens. 
Edit. 2d. Baltimore, 1813. 



2o8 BIBLIOGRAPHY. 

RlCHERAND, (Anthelme) — Nosographie chirur- 
gicale /peine edition, 1815. 5ieme 
edition, 1821. 

Herritz, (Aloysius Benedictus) — Diss, sistens 
notiones quasdam de summis mor- 
borum generibus. Viennae, 181 5. 

DURET, (J. J.) — Tableau d'une classification 
generale des maladies. Paris, 181 5. 

Good, (John Mason) — A physiological system of 
nosology, with a corrected and sim- 
plified nomenclature. London, 1817. 

GOOD, (J. M.) — The study of medicine. London, 

1822. 

Bateman, (Thomas) — Delineations of cutaneous 
diseases, etc. London, 18 17. 

Seigneur-Gens. — Nosographie Generale. 1818. 

Alibert, (Le Baron J. L.) — Nosologic naturelle, 
ou les maladies du corps humain dis- 
tributes par families. Paris, 1818 — 
1838. 

Hosack, (David) — A system of practical nosol- 
ogy, etc. New York, 1818 — 1821. 

PlNEL ET Bricheteau. Article nosographie 
dans le Dictionaire des Sciences 
Medicales. Tome 36. Paris, 18 19. 



BIBLIOGRAPHY. 209 

Barbier, (J. B. Q.) — Precis de nosologic et de 
therapeutique (unfinished). Paris, 
1827. 

BoiSSEAU, (F. G.) — Nosologic organique, ou 
traite complet de medecine pratique. 
4 vol. 8 vo. Paris, 1828. 

Struve, (L. A.) — Synopsis morborum cuta- 
neorum secundum classes, genera, 
species et varietates. Berlin, 1829. 

PlORRY, (P. A.) — Traite de Medecine Pratique 
et de Pathologie iatrique on medi- 
cale : Polygraphies ou generalites. 
Vol. 1, 1 841. 

Delorme, (Raige) — Article pathologie in the 
Dictionnaire de Medecine, second 
edition, vol 23. Paris, 1841. 

BouiLLAUD, (J. B.) — Traite de Nosographie med- 
icale. Paris, 1846. 

AlTKEN, (William) — Science and practice of 
medicine. Article nosology — con- 
taining Doctor William Farr's classi- 
fication. 

The nomenclature of diseases drawn up by a 
joint committee of the Royal College of Physi- 
cians of London. London, 



A nomenclature of diseases with the reports of 



2IO BIBLIOGRAPHY. 

the majority and of the minority of the commit- 
tee thereon. Presented to the American Medical 
Association at the meeting- held in Philadelphia,, 
May, 1872. Philadelphia, 1872. 

Nomenclature of diseases prepared for the use 
of the medical officers of the United States 
Marine Hospital Service, by the Supervising- 
Surgeon, John M. Woodworth, M. D., being the 
classification and English-Latin terminology of 
the provisional nomenclature of the Royal Col- 
lege of Physicians, London. Washington, 1874. 

Nomenclature of diseases. State Board of 
Health of New York (No. 65). New York, 1883. 
Paul, (F. T.) — A classification of the new. 
growths of the urinary system (Blad- 
der, Prostate, and Kidney). British 
Medical Journal, January 12th, 1884. 

Bronson, (E. B.) — The objects of dermatological 
classification, with especial reference 
to Auspitz* system. Pamphlet, pp. 
Reprinted from the Journal of Cu- 
taneous and Venereal Diseases. VoL 
II, June, 1884. 
The nomenclature of diseases drawn up by a 

joint committee appointed by the Royal College 

of Physicians of London. Second edition, being 

the first revision. London, 1885. 



BIBLIOGRAPHY. 211 

Rabagliati, (A.) — Some remarks on the classifi- 
cation and nomenclature of diseases. 
(Reprinted from the Medical Press 
and Circular). London, 1886. 

Smith, (Joseph R., U. S. Army)— On the best 
form of report of the sick and 
wounded of Armies. A paper read 
before the Section on Military and 
Naval Surgery and Medicine of the 
Ninth International Medical Con- 
gress. September, 1887. 

Bronson, (E. B.) — A study of the considerations 
relating to the classification of skin 
diseases with an attempt to con- 
struct a logical system in accordance 
with fundamental principles of etiol- 
ogy. Pamphlet, pp. 19. Reprinted 
from the Journal of Cutaneous and 
Genito-urinary diseases. October, 
1887. 



212 



SECTION IV. 

BASIS AND METHOD OF THE CLASSIFICATION 

AND CHARACTER OF THE NOMENCLATURE 

OF THE DISEASES OF MAN. 

Many high authorites opposed to classification. To think is 
to classify. Characteristics of good classifiers. Modern 
classifiers use terms of classification arbitrarily without taking 
the pains to define these terms. Nosography on the basis of 
symptoms misleading and retrogressive. Anatomy the only 
stable basis for nosography. Description and definition of dis- 
eases. Methods of the nosographer. The use of the dead 
languages in nomenclature. The names of men should not be 
applied to diseases. Suggestions for an improved classifica- 
tion of diseases. A consense of views necessary in the use of 
terms of classification. Questions suggested for discussion 
at the Tenth International Medical Congress. Definitions of 
the terms of classification. 

As preliminary to the further consideration of 
human nosography, the following questions may 
with propriety be propounded : 

1. Is there need of classification of any kind ? 

2. If so, what should be the basis of the classi- 
fication of diseases? 

3. What should be the character of the nomen- 
clature of diseases ? 

4. What should be the method of the classifica- 
tion of diseases ? 



NEED OF CLASSIFICATION. 21 3 

An answer to each of these questions will now 
be submitted to the decision of the medical pro- 
fession, for no official nosography should be 
established except with the concurrence of the 
medical profession. 

I. IS THERE NEED OF CLASSIFICATION OF 
ANY KIND? 

Despite the well known aphorism, " system is 
the Ariadnean thread without which all is confu- 
sion," some of the highest authorities in science 
have been opposed to methodical arrangement. 
Among them may be cited the celebrated Buffon. 
Many of the physicians of the present time do 
not approve of classification notwithstanding the 
fact that medicine is a science only by reason of 
the methodical arrangement of diseases, and that 
these physicians themselves are constantly classi- 
fying, for they think and therefore classify, and it 
is a fact that to think is to classify, therefore in 
thinking they classify nolens volens* To think of 



* " Looking to the experience of the past, it cannot, 

with any reason, be urged that systematic arrangements, if 
consistent with existing knowledge ever cramp or hamper a 
man in carrying out scientific investigations ; on the contrary, 
they enable him to see more clearly in what direction his la- 
bor must be advanced, and demonstrate more forcibly than 
otherwise the deficiencies of his knowlege." (Aitken.) 



214 BASIS OF CLASSIFICATION. 

an object is to recognise the properties which dif- 
ferentiate it from other objects and consequently 
place it in its proper class. — Particular illustra- 
tions need not be given. — But to make a general 
classification accurate and useful requires pro- 
found thinking, a good understanding, sound 
judgment, persevering study, careful observa- 
tion, persistent labor, untiring industry, and the 
co-operation of many men possessing these quali- 
ties. Nosotaxy however to be of practical utility 
to the medical profession, and of much benefit to 
mankind, requires more than the co-operation of 
many men. It exacts the prompt and substantial 
aid of the very great majority of all true physi- 
cians in the world. 

The answer to the first question is that there is 
great need of a classification of the diseases of 
man, established upon a proper basis, which shall 
constitute an epitome of the science of medicine. 

2. WHAT SHOULD BE THE BASIS OF THE 
CLASSIFICATION OF DISEASES? 

During this century nosography has not ad- 
vanced so rapidly as might have been reasonably 
expected. Among the chief reasons of this hin- 
•derance are; (i,) that the establishment of a 
proper basis for its development has never been 



BASIS OF CLASSIFICATION. 21 5 

agreed upon by the medical profession, and (2,) 
that no particular system of classification has been 
officially adopted by the profession. Individuals 
and certain nations having each some special sys- 
tem of classification and nomenclature of diseases, 
with no apparent aim toward uniformity. In 
sundry nosographical arrangements the words 
groups, sections, classes, orders, families, tribes, 
genera, and species, are so loosely and carelessly 
employed that it is difficult to understand the 
meaning which these terms are intended to con- 
vey, used, as they often are, in violation of estab- 
lished principles of classification, for many classi- 
fiers employ them arbitrarily and do not take the 
pains to give their own definitions of these arbi- 
trary terms. 

The starting point in nearly all the systems of 
nosography is the symptom. This has led astray 
many nosographers who, mistaking symptoms for 
diseases, placed these symptoms in the category 
of diseases, notwithstanding the existing excellent 
rules for the guidance of the student of noso- 
graphy. The system of Cullen having been 
judged the best was, for many years, in general 
use, and yet it was full of the most glaring errors, 
some of which he acknowledged in after years. 
Many of Parr's suggestions were excellent, but 
his system was as ill founded as those of his pre- 



2l6 BASIS OF CLASSIFICATION. 

decessors. Pinel's " nosographie philosophique " 
which superseded the nosology of Cullen in 
France, has long been obsolete. It failed, even 
after a very considerable number of revisions, 
probably because it was established upon the 
same faulty basis as that of former systems. The 
nosographical contributions of Recamier, of 
Richerand and of others had no better success. 
More than forty years ago Doctor Williams 
classified and tabulated certain diseases upon a 
physio-pathological basis, but there halted. 

It seems clear that the great defect of all these 
systems is the lack of a stable basis upon which 
to erect the structure of nosography. This defect 
was long ago realised but not remedied, and 
nosography had already shown signs of decay 
when it was almost entirely reconstructed by 
Doctor William Farr and by the Royal College 
of Pysicians of London. But even the modern 
English system is full of inconsistencies although 
it is declared to be founded upon anatomy. 

It is noteworthy that nearly all the early gen- 
eral nosographers were at either extreme of 
adopting very few or very many classes, and that 
they failed to agree as to what should constitute 
classes, orders, genera, species, or symptoms, for 
these are scattered throughout what at first sight 
seem to be the most methodical arrangements. 



BASIS OF CLASSIFICATION. 217 

Thus phlegmasiae are placed among classes by 
Sauvages, Linnaeus, and Sagar, and among or- 
ders by Cullen, Vogel, Macbride, and Good. 
These, and many other blemishes already pointed 
out, occur from the time of Sauvages to that of 
Hosack, and are owing partly to the fact that too 
little attention has been bestowed upon species 
notwithstanding the caution of Cullen who, how- 
ever, fell into the error he so much wished to 
avoid, and partly to the state of knowledge of 
physiology and morbid anatomy at that epoch. 
Although Doctor Good based his nosology upon 
physiology, he reaffirmed many of the errors of 
the older authors. 

This want of agreement, and the absence of a 
substantial foundation and of associated harmoni- 
ous labor, have given rise to the greatest confu- 
sion in the use of terms and in arrangement. 
This confusion and the tendency of each noso- 
grapher to reproduce the inaccuracies of his pre- 
decessors, have greatly impeded the progress of 
nosography and have led to much unfavorable 
criticism and to the frequently asked question, 
" of what use is nosography " ? — This question is 
now often sneeringly asked by those who fail to 
appreciate the fact that, without the existing sys- 
tematic arrangement of diseases, they could not 
have learned, and could not intelligently and sue- 



218 BASIS OF CLASSIFICATION. 

cessfully practise, medicine. — In the beginning of 
this century nosography was not regarded with 
much favor by many learned physicians both in 
England and on the continent of Europe, and the 
mass of the profession spoke of it contemptu- 
ously. Doctor Parr, in commenting thereon 
says : " nosology is seldom mentioned but to be 
ridiculed and despised." * 

Under the same head, Parr says : 

" Systems are the work of our own minds ; for 
nature advances by almost imperceptible shades ; 
and where we cannot point out the termination 
of one family, and the commencement of another, 
it is only confessing that the intermediate link is 
unknown : thus when our knowledge advances 
the advantages of our system lessen, for our lim- 
its are lost 

" If a foundation could be obtained, it was ap- 
parently by considering the disorder as connected 
with an internal change, which would then afford 
what might be styled an object, whose properties 
we might examine. . 

" The great advantage of nosology is distinc- 
tion, discrimination, etc We still 

want a delineatio morbi'm imitation of the delineatio 
plantae in Linnaeus." 



* The London Medical Dictionary. London, 1809. 






BASIS OF CLASSIFICATION. 219 

How can proper distinction, discrimination, 
and a delineatio morbi be made unless nosography 
have a stable foundation such, for instance, as 
can be built from anatomy ? As early as the 
year 1801 Bayle was of opinion that nosography 
should be founded upon anatomy, but the idea 
was never fully carried out, although Alibert 
named his families of diseases in accordance with 
the organs affected, although Richerand and 
others made similar attempts, and although the 
modern English system is avowedly founded 
upon anatomy.* 

It was an error of much consequence on the 
part of the nosographers to make symptoms the 
foundation of the science instead of using them 
as one of the means by which to discover individ- 
ual diseases. An anatomical foundation would in 
no way have lessened the importance of symp. 
tomatology and of semeiology, for, however sub- 
stantial might have been the foundation of noso- 
graphy, its superstructure could never have been 
built without proper methods of detecting and of 
expressing the characteristics of diseases. It is 



* The latest work of Sauvages (published a year after his 
death) contained a symptomatical, an etiological, and an 
anatomical arrangement, but the etiological and anatomical 
were held in entire subordination to the symptomatical ar- 
rangement. 



220 BASIS OF CLASSIFICATION. 

chiefly by the aid of symptoms and signs that in- 
dividual affections are recognised and species 
established, and it is from species that the super- 
structure rises. 

While due consideration should be given to 
symptoms, it would, in the present state of 
science, seem unwise to attempt to make a 
delineatio morbi solely upon the basis of symp- 
toms, for, without placing under contribution 
aetiology and pathoanatomy, it would not be 
possible to fix a term for every circumstance in 
which the morbid conditions might vary. For 
example, in the case of a deformity, the descrip- 
tion of its external charaters would be insufficient 
and its definition inexact if the cause and pathic 
properties were not set forth. This cause may 
be an injury, or a previous disease, or the de- 
formity may be congenital. Again, an echmatic 
affection may be owing to a congenital anomaly, 
to a previous disease, or to an injury. A tumor 
may consist of fat, or of muscular or fibrous tis- 
sue, of cartilage, or of bone, or of cellular ele- 
ments which are rapidly proliferated to be soon 
destroyed. In such cases, symptoms would in- 
dicate simply the existence of a tumor of a cer- 
tain size and shape and its immediate effects, but 
not its anatomical properties. To make the de- 
scription of an abnormal condition of the human 



BASIS OF CLASSIFICATION. 221 

body accurate and its definition exact, all the cir- 
cumstances connected with it should be closely 
scrutinised and analyzed, whether they be ex- 
ternal manifestations, or physical signs brought 
to light by the aid of certain tests systematically 
applied, as for instance, in the case of the sense 
of hearing in auscultation, of touch in palpation, 
or of other methods of physical exploration. At 
the same time the greatest importance should be 
attached to the causes and to the pathic proper- 
ties of these conditions as revealed by the mod- 
ern appliances for determining the anatomical 
and other characters of diseases, such as chemical 
tests, the electrical apparatus, the microscope, 
the polariscope, and other instruments of pre- 
cision. 

Culien speaks of the difficulty he experienced 
in determining what is really a true species and 
what is only a variety, and finds it necessary to 
enumerate many varieties. This difficulty doubt- 
lessly arose from his adopting a system based 
upon symptoms rather than upon anatomy. Some 
of his rules for discriminating between species 
and varieties would now be of little value and 
must have been very unsatisfactory in his own 
time. For instance, it could not have been easy 
to form a clear conception of what is " a symp- 
tom of a symptom," or of "a symptom of a 



222 BASIS OF CLASSIFICATION. 

cause." The "symptoms of symptoms" have 
been denned as " effects which result from 
the symptoms of a disease, but which are not 
necessarily allied to the disease," and the follow- 
ing example is given : "thus the debility which 
results from the frequency of the alvine evacua- 
tions in dysentery is a symptom of symptoms." 
All this has been handed down from the time of 
Cullen and seemingly accepted without demur or 
comment on the part of the profession and re- 
corded by such authors as Dunglison, Littre and 
Robin, and other writers of eminence. From 
symptoms effects cannot arise, for symptoms are 
only manifestations of a morbid condition which 
is itself the effect of a cause. The idea of an ef- 
fect arising from a manifestation is therefore most 
irrational. The debility which results from such 
phenomena as the frequent alvine evacuations in 
dysentery is a consequence and not a symptom 
of the dysentery. The outward manifestations of 
dysentery are the frequent bloody alvine evacua- 
tions accompanied by tenesmus. The analysis of 
these symptoms furnishes a sign upon which to 
base the diagnosis of the disease. 

There are no " symptoms of a cause " any 
more than }here are " symptoms of symptoms." 
The cause produces an effect — disease — which 



BASIS OF CLASSIFICATION. 223 

effect manifests itself by certain general or local 
symptoms. 

Of late years it has been proposed to employ 
two classifications and nomenclatures, one for the 
clinician, based upon the characters of the symp- 
toms of disease, and one for the pathologist, to 
be used in the autopsy room. Such a system 
would be entirely unnecessary if a single classi- 
fication and nomenclature were placed upon a 
proper foundation. 

The modern botanical classification is based 
upon the reproductive organs of plants, that is, 
upon anatomy. 

Zoological classification is likewise based upon 
anatomical characters, and this basis was adopted 
to a certain extent by Buffon, notwithstanding 
his general opposition to methodical arrange- 
ment, by Pennant in his history of quadrupeds, 
published in 1781, and by other zoologists of their 
time. 

Looking at the inorganic world, it will be seen 
that the classification of minerals is based upon 
their chemical properties. The system adopted 
by the mineralogists includes classes, orders, 
species and varieties. 

The chemical nomenclature of the present, the 
result of more than a century of arduous labor, is 
based upon the composition of compound sub- 



224 BASIS OF CLASSIFICATION. 

stances, so that the name of a chemical compound 
generally indicates its exact composition. 

All s) T stematic studies of those sciences wherein 
the greatest advances have been made during 
this century, are established each upon a rational, 
a substantial basis, except medicine ; and why 
the good example set by the naturalists has not 
been more generally followed by medical writers, 
it is not easy to explain. 

A nosography based upon sysmptoms cannot 
be accurate and must necessarily fall. 

To be of practical utility, the classification of 
diseases should be based upon anatomy. This is 
the answer to the second question. 

In this work therefore, an attempt is made to 
raise the superstructure of nosography upon this 
foundation. 

Dr. Clymer, whose opinion was asked in rela. 
tion to the question of the basis of classification 
of diseases, writes as follows : 

" The first attempts towards a classification of 
diseases are, necessarily along the lines of symp- 
toms. They are the objective marks of disorder ; 
the salient signs that compel attention. In an 
early state of study, with defective knowledge of 
substance and its properties, they offer the one 
conception of departure from sound working we 
can have. True scientific research is bottomed 



BASIS OF CLASSIFICATION. 225 

on observation. The unknown cannot be made 
the subject of positive thought. Cognition is 
conditioned on experience, which comes through 
perception ; and a right understanding of phe- 
nomena must be within the limitations of ex- 
periences, and can be studied successfully only 
by this method. 

" When we get to a better knowledge of sub- 
stance, its forces, and their variations, the artifice 
classification, based on positive data, becomes 
possible. It will be more or less perfect in 
proportion to the degree and fulness of such 
knowledge. Berkeley says : ' We know a thing 
when we understand it ; and we understand it, 
when we can interpret, or tell what it signifies.' 

" When the square of the hypotheneuse is 
geometrically demonstrated, no one has a right 
to his own notion about it. 

"Facts of phenomena arise from facts of sub- 
stance, otherwise they are facts of fancy. Symp- 
toms looked at alone as such and not coupled 
with the suffering substance whose speech they 
are, and by which its troubles are told, will mis- 
guide or give no hint of the true state ot things. 
Necessitated correlation of matter and force is a 
primal law. No change in the customary expres- 
sion of an activity, whether by increase, lessen- 
ing, arrest or perversion, may happen, without, 



226 DESCRIPTION AND DEFINITION. 

at like time, a change, coarse or fine, in the plas- 
mode. Hence, as a matter of fact, there can be 
no such thing- as mere functional disorder apart 
from structural damage. This would be an ab- 
straction, as it supposes a quality without sup- 
port, which is meaningless and contradictory. 
We can neither know, or be ignorant of an ab- 
stract thing. 

"Facts of quantitative or qualitative disturb- 
ance, made known by objective or subjective 
tokens, can, therefore, be only truly expressed in 
terms of substance." 

DESCRIPTION AND DEFINITION. 

Summarising what has already been stated as 
to the scope of nosography, it is found to include : 
(i,) the description; (2,) the definition; (3,) the 
nomenclature; and (4,) the classification of dis- 
eases. 

The description of a disease is the setting forth, 
in detail, of its cause, nature, pathoanatomy, 
and symptoms. 

The definition of a disease is the statement of 
its peculiar, dominant, and constant characteris- 
tics so concisely and clearly, that it can be readily 
recognised. 

Description and definition are too often con- 



CHARACTER OF THE NOMENCLATURE. 227 

founded. An exact definition is the summary of 
an accurate description. It takes from such de- 
scription only what is essential to precisely 
characterize a disease and distinguish it from any 
other disease. An exact definition can therefore 
be deduced from the analysis only of a complete 
description. 

In the description of a disease there may be 
symptoms and other conditions which are com- 
mon to two or to more than two diseases. To in- 
troduce such characters into a definition would 
vitiate and render it useless. 

The methodical nosographer first describes a 
morbid condition. From this description he ex- 
tracts the definition and from the definition ob- 
tains the correct name of the disease which he 
accordingly classifies. 

3. vVHAT SHOULD BE THE CHARACTER OF 
THE NOMENCLATURE OF DISEASES? 

Nosonomy* or the nomenclature of diseases is 
that division of nosography about which there is 



* Nosonomy, from vo6o$, disease, and ovo/ia, name. The 
words know and name are said to be traceable to the same 
root. Diseases to be properly named should therefore first be 
well known. 



228 CHARACTER OF THE NOMENCLATURE. 

the least agreement among both the ancient and 
modern authors ; consequently, of all scientific 
nomenclatures, that of medicine is confessedly 
the most defective. Of the many good rules pre- 
scribed for naming diseases, few have been ob- 
served, and many of the most absurd and mean- 
ingless terms, anciently adopted, are still 
obstinately retained. A pernicious habit of in- 
accuracy among writers has been the outcome of 
this faulty nomenclature which now proves to be 
one of the greatest detriments to the science and 
art of medicine. Although repeatedly pointed 
out, no concerted international action has been 
taken for the remedy of this evil. The nearest 
approach to reformation is indicated by the work 
done, in the past thirty years, by the medical pro- 
fession of the advanced European nations, more 
particularly of England. Most of the labor, how- 
ever, was individual, and performed by the late 
Doctor William Farr, of London, who is entitled 
to the highest praise for his devotion to this sec- 
tion of nosography. He has done much to ad- 
vance nomenclature, but there remains much 
more of the same kind of work to be accom- 
plished. 

Sir VV. Aitken, who has also given great atten- 
tion to the question of nomenclature, summarises 
" the considerations which have generally reg- 



CHARACTER OF THE NOMENCLATURE. 229 

ulated the naming of diseases" as follows: "(i,) 
some names have been taken from the part 
affected — e. g., peripneumonia, podagra, opthal- 
mia, dysentery ; (2,) the most characteristic 
symptoms have furnished the name — e. g., ileus, 
tenesmus, paralysis, diarrhoea, dyspnoea, coma ; 
(3,) some names have been taken from these two 
circumstances combined — e. g., cephalalgia, otal- 
gia, cardialgia, odontalgia, hysteralgia ; (4,) an 
alteration of tissue upon which subsequent 
changes depend being recognised as the essen- 
tial element of the disease, it is named accord- 
ingly — e. g., pleuritis, peritonitis; (5,) such 
alteration not being discovered, the first tangi- 
ble link in the chain of causation has been 
used instead — e. g., melancholia, cholera, typhus ; 
(6,) when a lesion tending to sudden death at 
once follows the application of a cause, that cause 
may name the disease — e. g., lightning, prussic 
acid, arsenic, scald, sun-stroke, cut, stab, frost- 
bite, etc. ; (7,) a considerable number of names of 
diseases have been derived from some imaginary 
resemblance to external objects — e. g., elephanti- 
asis, cancer, polypus, anthrax, etc. ; (8,) there are 
still many names the origin of which it is not 
easy to trace." 

Faulty as are these and many other terms, it is 
extremely difficult to fill their places with suit- 



230 CHARACTER OF THE NOMENCLATURE. 

able expressions. That this will in time be ac- 
complished — perhaps however not until two or 
three generations of physicians shall have passed 
away — is reasonably to be anticipated. Mean- 
while it is to be hoped that during the present 
generation good substitutes will be offered for 
such caconymous terms as podagra, rheumatism, 
apoplexy, melancholia, ileus, dysentery, diar- 
rhoea, cholera, typhus and typhoid fevers, 
variola, diphtheria, hydrophobia, elephantiasis, 
lupus, leprosy, anthrax, cancer, chancre, chan- 
croid, scrofula, syphilis, and a host of other 
equally inappropriate names of diseases. 

Many of these terms are used in this essay — 
but under protest — until, by general agreement, 
correct terms shall be substituted. 
v " The perfection of a science depends, in no 
inconsiderable degree, upon the perfection of 
its language ; and the perfection of every lan- 
guage upon its simplicity and precision." * 

The language of medicine should be euphoni. 
ous, simple, expressive, and accurate, for, its ob- 
ject is not only to describe and define diseases 
with precision, but to mirror the medical ex- 
perience, wisdom, and genius of the past as well 
as of the present. Nosographical nomenclature 



* John Mason Good. 



CHARACTER OF THE NOMENCLATURE. 23 I 

is the most important part of medical language 
and consists of the technical terms therein used. 
This nomenclature should be based upon the 
structural characters, of the affections of the hu- 
man body ; therefore the names given to diseases 
should convey to the mind an exact idea of the 
morbid conditions which these names are de- 
signed to express, at least a strong endeavor 
should be made toward the attainment of that 
end.* As a general rule these names should be 



* " The exactness of names and the uniformity of terms 
render more facile and prompt the knowledge of a science, 
and an expressive and characteristic denomination makes a 
profound impression upon the mind which necessarily puts 
the object designated into the place of its designation." 
(Paraphrased from Condillac by Pinel.) 

Condilliac in commenting upon nomenclature propounded 
the following aphorism. " Les sciences se reduisent a des 
langues bien faites." This may be liberally translated into, 
sciences may be reduced to exact language. 

" It is the exactness and also the good use of words, or 
more generally of signs, which should be considered as the 
criterion of the truth ; it is to their vague character, to the un- j 
certain and confused manner in which they are employed, that 
should be attributed imperfect notions, prejudices, errors, and 
all vicious habits of the mind. 

" In nearly all the departments of medicine, the language is 
ill constructed. It has been more and more corrupted by the 
false application of words borrowed from the other sciences, 



232 CHARACTER OF THE NOMENCLATURE. 

Latin or Latinised Greek, or of Greek or Latin 
derivation but should not be compounded of 
Latin and Greek. To avoid confusion it is de- 
sirable that one name only be adopted for each 
individual disease. When a disease already bears 
several names, if one of these be accurate it 
should be adopted to the exclusion of the super- 
fluous or improper names, otherwise a correct 
term should be coined, and the other names 
should be placed under the head of equivalents, 
synonyms, or caconyms, as the case may be. 

The names of men applied to diseases are ex- 
tremely objectionable, convey no idea of the 
nature of these diseases, and even fail to flatter 
vanity. It happens sometimes that a disease 
bears the names of two persons whose descrip- 
tion thereof is the same. May it not also happen 
that one and the same disease is very differently 
described by two or even three persons, each giv- 
ing his name to the disease, so that two or three 
diseases may be enumerated where only one 
exists ? The resulting confusion and perplexity 
would, in such a case, be most discouraging to 
earnest students. The fashion of giving men's 

and by a certain insignificant and ridiculous jargon which has 
too often been adopted by physicians owing to a culpable re- 
spect for popular prejudices." (Cabanis.) 



CHARACTER OF THE NOMENCLATURE. 233 

names to diseases has continued through so long 
a series of years that it has grown into a con- 
firmed and mischievous habit. If this sentimental, 
but mistaken, notion of honoring or of rewarding 
merit could have been limited, no great harm 
would have ensued. The evil is however already 
an offensive blot upon the nomenclature of medi- 
cine, and threatens to mar the best pages of 
medical literature. Will it not be a most agree- 
able relief to the senses of the heedful reader 
when authors shall have banished from their 
treatises such terms as Addison's disease, Base- 
dow's disease, Bright's disease, Charcot's disease, 
Duchenne's disease, Dupuytren's contraction, 
Graves' disease, Hodgkins' disease, Meniere's 
disease, Pott's disease, and very many more of 
kindred names which express no notion of the 
nature of the affections bearing such pseu- 
donyms ? 

The names of regions of country — e. g., Bar- 
badoes leg ; of animals — e.g., lupus, elephantia- 
sis; of vegetables — e.g., hay fever; of some of 
the elements — e. g., St. Anthony's lire ; and 
other names too absurd and too numerous to 
particularise have been given to diseases. 

The same faulty nomenclature exists in the 
fundamental science and associated arts of medi- 
cine. 



234 CHARACTER OF THE NOMENCLATURE. 

It is to be hoped that the much desired general 
reformation in medical nomenclature will soon 
begin, but the bad foundation must first be 
sapped by a radical change in the nomenclature 
of the fundamental science and associated arts of 
medicine. 

The answer to the third question is that the 
nomenclature of diseases, to be exact, should be 
based upon the true nature of morbid conditions 
and should be characterized by simplicity, brev- 
ity and accuracy. 

Inasmuch as many of the words employed by 
the earliest nosographers are now largely used, 
and inasmuch as their use will probably be con. 
tinued for a long time, it is proper that the inten- 
tion of their coinage be clearly understood. 
Doctor John Mason Good's nosology contains a 
full explanation of many of the terms employed 
by Sauvages and other contemporaneous nosog- 
raphers, and also a table of some of the medical 
prefixes and terminals with a brief statement of 
the senses in which they are applied. This table 
of prefixes and terminals is here reproduced for 
the benefit of those who may desire to know their 
exact meaning as understood when they were 
coined. 



235 
good's table of prefixes and terminals 
with the senses in which they 

ARE USED * 

Prefixes. 
A, (a), Diminution or less quality or power. 

f For the most part 

a ^ u / ~ ^ \ iterative, duplicate, 

Apo, ap, aph, (aito y an, atp). Z j 

f i k> k . » -r/»j or augmented ac- 

Cata, cat, ««r«, «ar, . p , 

' ' | tion : but often in- 

[ determinate. 

Dia, (<5*a), Separation ; secernment ; or secretion. 

Dys, (<5t>e), Morbid state or action generally, era- 
phatical, when accompanied with dis- 
tress or difficulty. 

EpUp/eph^,.*,^),} 0ut of = onwards; 
Hyper, M, j over; above. 

Hypo, (vito), Under. 

En, («v), Within ; below ; applied to places. Su- 
periority ; excess or intensity ; applied 
to quantity or quality. 



* A more extended table of prefixes and terminals is to be 
found at the end of Volume I, of Piorry's " Trate de Medi- 
cine Pratique et de Pathologie Iatrique ou Medicate. 
Generalites." 1841. 



236 PREFIXES AND TERMINALS. 

Para, inapa), Morbid state or action generally ; 
and hence synonymous with dys\ 
except in a few terms derived from 
anatomy, in which it imports apud, 
" bordering on," as in parotitis, pa- 
ronychia. 

Peri, (itepi), Circuit; circumference. 

Terminals. 

Algia, {a\yia), Pain or ache. 

~) Morbid action, pow- 
Asmus, osmus, {ad/ia, 06110$) | er, or possession 
Esmus, ismus, (ad/ios, idjuos), I generally ; but 
Esis, osis, (edis, codis) } mostly very inde- 

J terminate. 

Iasis, (iadis), Cutaneous eruption, unconnected 
with fever as its cause. 

ltis, (zr*7S), Organic inflammation. 

Kele, cele, (xy&y), Covered protrusion of a soft 
part. 

Odes, (008175), Like ; akin to. 

Oma, (<»/*«), External protuberance. 

Ptoma, (nrcojua), Naked prolapse of a soft part. 

Rhoea, (poia) } Preternatural flux of any fluid ex- 
cept blood. 

Rhagia, (payia), Preternational flux of blood. 



METHOD OF THE CLASSIFICATION. 237 

Latin terminals. 
Igo, Diffuse or migratory action or motion. 

Ilia, ula, ) c . , j. . . 

Illaris ularis \ ^ im P le diminutive terminations. 

Osus, Simple augmentive termination. 

4. WHAT SHOULD BE THE METHOD OF THE 
CLASSIFICATION OF DISEASES? 

Nosotaxy or the classification of diseases. — The 
fourth division of nosography relates to the 
grouping of those diseases that have been de- 
scribed, defined, and named, and to their arrange- 
ment into distinct classes, orders, genera, and 
species. This is called taxonomy * or classifica- 
tion. 

Next to nomenclature, classification has exhib- 
ited the most diversified and incongruous views. 
At the close of the last, and in the beginning of 
this century, classification was in such fashion 
that every prominent physician thought himself 
bound to construct a new classfication of dis- 
eases. The result was that no two systems agreed ; 
and that nearly all classifiers not only repeated the 



* Taxonomy, from rct^iS, arrangement, and vojuoS, a law 
and, for the sake precision and brevity, nosotaxy, the classifi- 
cation of diseases. 



238 METHOD OF THE CLASSIFICATION. 

heresies of their predecessors, but often made 
greater mistakes, so that nosography soon fell 
into disrepute and contempt. The excessive 
zeal displayed by many of these classifiers in en- 
deavoring to promote nosography, and their pre- 
mature publication of imperfect and ill digested 
systems, are among the main causes of the re. 
tardation of its progress. 

Sir W. Aitken, in his warm advocacy of meth- 
ical arrangement, predicts a glorious future for 
nosography. 

He says, under the head " principles of classi- 
fication " : 

" A perfectly philosophical or natural system 
of classification aims at having the details of its 
plan to agree in every respect with the facts as 
they exist in nature, and to be as it were a ' trans- 
lation of the thoughts of the Creator into the 
language of man.' To effect this end, arrange- 
ments, as they naturally exist, require to be 
traced out, not devised. The tracts in which our 
knowledge is as yet deficient, may be shortly in- 
dicated under the following heads: (1,) the 
affinities or alliances of diseases with each 
other ; (2,) the morbid anatomy of diseased parts i 
(3,) the communication, propagation, inoculation, 
generation, development, course, and spontaneous 
natural termination of diseases ; (4,) the connec- 



METHOD OF THE CLASSIFICATION. 239 

tion of the phenomena recognised during life 
with the facts of morbid anatomy ; (5,) the geo- 
graphical distribution of diseases ; (6,) the suc- 
cession of diseases, so far as they can be traced 
through past ages; the peculiarities they have 
exhibited at different periods in the world's his- 
tory, or within comparatively recent cycles of 
years. " But," he further says, "the time has 
not yet come for a classification on a basis so 
comprehensive — simply because the material 
does not yet exist; and attempts to make so- 
called natural systems of arrangement must end 
in disappointment, on account of the uncertain 
and fluctuating data on which they must be 
based." 

It is true that the whole of the material does 
not yet, and may never, exist for " a perfectly 
philosophical or natural system of classification," 
but there is enough good material at hand, 
which, if wisely used, will greatly improve the 
present systems of classification. It surely is not 
the part of wisdom to wait an indefinite time to 
begin this work. Had the early nosographers 
waited for the " proper time to come," this 
science would, to-day, scarcely be in existence. 
But they quickly made use of such material as 
was then at hand and their labors have led largely 
to the advances which are at present enjoyed. 



240 METHOD OF THE CLASSIFICATION. 

The succeeding generations of nosographers wil 
doubtless profit by the good work — and by the 
errors too — of the preceding, and it may possibly 
be many centuries before the fond hope of Sir W. 
Aitken can be realised, but the beginning should 
be made now. 

The task of improving the classification of dis- 
eases may be begun by individuals, but individual 
labor should, with good grace, be submitted to 
the criticism and correction of other individuals 
and of organized associations of the medical pro- 
fession, first of the country of these individuals, 
then of all countries of the world. 

The study of the nosography of the past, show- 
ing, as it does, such great diversity in the many 
systems, such lack of agreement among the no- 
sographers, such confusion in classification, and 
such eccentricity in nomenclature, must needs 
lead to the conclusion that it is not possible, in 
the existing state of medical science, for any one 
person, or for a single association, or even for the 
medical profession of one or of several nations to 
produce a complete general nosography. The un- 
successful efforts already made in this direction 
for the past century and a half are good evi- 
dences of the correctness of this proposition. 
Many individuals may each prepare the nosog- 
raphy of one apparatus of the human body and 



METHOD OF THE CLASSIFICATION. 241 

thus doubtless give substantial aid in the cause of 
nosography and contribute thereto much valua- 
ble material ; but, in view of the progressive 
character of medical science, the details of all 
such work must necessarily be provisional and 
constantly subjected to alterations and revisions. 
The final decision of questions relating to the 
general principles of nosography, and tending to 
make the nomenclature of medicine uniform in 
all countries, should be made by an assembly of 
representant physicians of all nations, through in- 
ternational conferences, so that every individual 
member of the medical profession may know that 
his voice shall be heard for or against the adop- 
tion of any proposed method of nomenclature 
and classification of the diseases of man. By this 
means only can a comprehensive system of no- 
sography be compiled which will be of practical 
utility to all nations for the purposes of vital 
statistics and of the medical reports of armies, 
navies, and general hospitals, or for the use of 
students, teachers and investigators. 

The answer to the fourth question is that the 
excellent method of classification, borrowed from 
the botanists, by the early medical classifiers, 
should be re-adopted with the modifications in- 
dicated below. 

If the majority of the medical profession of the 



242 METHOD OF THE CLASSIFICATION. 

world should decide in favor of classifying the 
diseases of the human body, as heretofore, like 
systems of botany, it would seem rational to base 
the classification upon anatomy in its broadest 
sense ; and such a basis is the one which offers 
the greatest advantages and the widest scope in 
theory and in practice. A knowledge of the 
gross appearances and of the construction and re- 
lations of the several parts of the body ; of the 
minute structure of the tissues and organs ; of 
the development and abnormities of the organs; 
of the functions of the apparatuses ; and of the 
nature of morbid conditions, is of the utmost im- 
portance. Nay more, a mastery of these various 
branches of anatomy is essential to the study of 
the natural history of diseases. By its aid, all de- 
viations from the normal state of the body or any 
part thereof are at once recognised. It remains 
only to differentiate these abnormal conditions 
and to define, name, and classify them. These, it 
seems, are sufficient grounds for the adoption of 
the anatomical basis for the nosography of man. 
It is therefore suggested that all diseases, in- 
juries, and congenital abnormities be grouped 
into families, one family for each apparatus of 
the body, and one or more than one family for 
general diseases. Some of the families should 
have two or more than two branches, and fami- 



METHOD OF THE CLASSIFICATION. 243 

lies and their branches should be divided into 
classes, orders, genera, species, sub-species, varie- 
ties and sub-varieties. 

It is of the utmost importance that, in the med- 
ical profession, there be a consense of views con- 
cerning not only nomenclature and methodical 
arrangement but also the use of the terms of 
classification. Notwithstanding the fact that the 
early nosographers indicated, as best suited to 
the purposes of nosography, the simple arrange- 
ment of diseases into classes, orders, genera, 
species, and varieties, the most recent of the 
modern medical classifiers begins with classes 
and after orders introduces " sub-orders, tribes, 
and families," next to which he places genera, 
species, and varieties. Such a method only leads 
to confusion, complication, and uncertainty. Sim- 
ilar methods have been tried in medicine and 
found wanting in clearness and accuracy. 

The plan proposed in this work does not in- 
clude sub-orders, or tribes. Families are applied 
to the groups of diseases dwelling in the appara- 
tuses of the body. 

The nosographer who lays before the profes. 
sion a system of classification is in duty bound to 
give an exact definition of each and every term 
of classification which he employs, in order that 
he may be rightly understood. 



244 QUESTIONS FOR THE TENTH 

Only those terms of classification that are ap- 
proved by the medical profession should be used 
in a special or in a general nosography. 

The sooner the question of method is put to a 
vote, after free discussion in an association rep- 
resenting the medical profession of the whole 
world, the better it will be for the cause of ac- 
curate nomenclature and classification. 

Therefore the following questions are sug- 
gested for discussion at the Tenth International 
Medical Congress. 

i. Shall there be instituted an International 
system of nomenclature and classification of the 
diseases of man ? 

2. If so, what shall be the basis of this nomen- 
clature and classification ? 

3. What shall be the character of the nomen- 
clature ? 

4. What shall be the method of the classifica- 
tion ? 

5. What shall be the nature of the terms used 
in the classification ? 

6. Shall these terms be defined ? 

In case the first question — shall there be insti- 
tuted an international system of nomenclature 



INTERNATIONAL CONGRESS. 245 

and classification of the diseases of man? — be de- 
cided in the affirmative, it is further suggested: 

1. That the International Medical Congress es- 
tablish a permanent section on the nomenclature 
and classification of the diseases of man, to be 
composed of physicians and surgeons represent- 
ing the medical profession of all nations. 

2. That all national medical associations like- 
wise establish each a section on the nomenclature 
and classification of diseases, composed of physi- 
cians and surgeous representing different regions 
of country, in order that their knowledge of the 
peculiarities presented by disease in differing 
climates may be made available in the work to be 
accomplished. 

3. That state, city, and special medical associa- 
tions, through their presiding officers, each ap- 
point a committee on the nomenclature and 
classification of diseases. — This can be effected 
without, in any way, deranging the machinery of 
these associations. 

4. That the city and special associations report 
to the State Associations such action as they may 
take upon the proceedings of their committees. 

5. That the reports of the city and special 
associations be embodied in the report of the 



246 INTERNATIONAL CONGRESS. 

State committee, and the consolidated reports be 
presented to the State Association for action and 
transmission to the national association. 

6. That the national association refer the state 
report to the national section on nomenclature, 
etc., for a report after careful examination and 
free discussion. The report to be acted upon by 
the National Association and forwarded, or pre- 
sented by a delegate, to the section on nomen- 
clature and classification of the International 
Medical Congress. 

7. That the section on nomenclature and classi- 
fication of the International Medical Congress 
then revise the several national reports, consoli- 
date them, and present their conclusions to the 
Congress whose decision thereon should be final. 

These suggestions are made in the belief that 
they point to a fair method of obtaining the views 
and the vote of the whole medical profession on 
a subject of the vastest importance to mankind, 
and also to the most expeditious way to attain 
the desired end of compiling a uniform nomen- 
clature and classification of diseases that may be 
of practical utility to all nations. 



247 

DEFINITIONS OF THE TERMS OF 
CLASSIFICATION. 

The following definitions of the terms of classi- 
fication are modeled upon botanical nomencla- 
ture, except those of family, class, and order, 
which do not here occupy the same relative posi- 
tions as in works on Botany and Zoology. 

1. Families of diseases* — A family is a group of 
diseases dwelling in an apparatus of the human 
body and affecting, in a greater or less degree, 
the organs of this apparatus and consequently its 
function. Therefore affections of the organs of 
an apparatus, and also general diseases affecting 
several apparatuses at once, should be grouped 
into families. 

2. Branches of families. — A branch of a family 
of diseases is a division of the family predicated 
upon affections peculiar to sex ; as in the case of 
the family of affections of the uro-genital appara- 
tus which should be divided into two branches, 
(i,) andrology, (2,) gynaecology; or upon the 



* Family, — iromfatm'lia, a family, and famulus, a servant, 
and SjuiXia, an assembly, and the Hebrew word which means 
to labor, — is the most general term, being those who are 
bound together upon the principle of dependence. 

Family includes in it every circumstance of connexion and 
relationship. (Crabb.) 



248 DEFINITIONS OF THE 

affections of an apparatus which includes two, or 
more than two subsidiary apparatuses, as in the 
cases of the cephalo-rhachidian, nutritive, and 
cutaneous apparatuses. 

3. Classes* — A class of diseases is ordinarily 
defined as a division of diseases grouped together 
on account of their common characteristics. In 
this case, however, the term class is used to 
signify a group of diseases which, though possess- 
ing different characteristics, affect a particular 
organ. In this system, therefore, the classes have 
reference to, and bear the anatomical denomina- 
tion of, the organs of an appparatus. 

4. Orders.\ — An order is an association of 
genera or a group of the general morbid condi- 
tions of allied affections of particular organs. 
The orders, therefore, refer to the general de- 



* Class, from classis very probably from the Greek nXcitiiS, 
a fraction, division, or class. Class is more general than order. 
" Classification is a branch of philosophy which is not attaina- 
ble by art only, it requires a mind peculiarly methodical by 
nature, that is capable of distinguishing things by their 
generic and specific differences ; not separating things that 
are alike ; nor blending things that are different." (Crabb.) 

t Order, from ordo, from opxoS, a row, which is a species 
of order, is applied to everything which is disposed. The 
order lies in consulting the time, the place and the object, so 
as to make them accord. (Crabb.) 



TERMS OF CLASSIFICATION. 249 

nomination of the morbid condition of the organs 
of an apparatus. 

5. Genera* — A genus is an assemblage of spe- 
cies possessing certain characters in common. 
The genera, therefore, refer to the particular de- 
nomination of the morbid condition of the organs 
of an apparatus. 

A single species having distinctive characters 
that seem of more than specific value may con- 
stitute a genus. 

6. Species.^ — A species is a permanent series of 
similar individual affections associated on account 
of their common properties. These properties 
are to be determined only by the closest observa- 
tion of abnormal conditions of the human body. 
Species, says Cullen, " are ready made by na- 
ture" (he would have been more exact had he 
said, the individual diseases which constitute 
species are ready made by nature) ; the nosog- 



* Genus, from gignere, from yevEiv, to engender, "is a 
class of objects divided into several subordinate species." 
(Webster.) 

t Species, from spicere, to behold, signifies literally the 
form or appearance, and in an extended sense that which 
comes under a particular form. Species is a term used by 
philosophers, classing things according to their external or in- 
ternal properties." (Crabb.) 



250 DEFINITIONS OF THE 

rapher has only to discover and name them, but 
the orders and genera he must construct — not 
according to fancy, but to reason and to definite 
rules. Species are therefore named in accordance 
with the general specific properties of the affec- 
tions of the organs of an apparatus. 

7. Sub-species. — A sub-species is a subordinate 
species, possessing distinctive characters that are 
of more specific value than those of a variety. 
On this account it occupies a middle position be- 
tween the species and the variety. 

8. Varieties* — A variety is a form of species 
possessing peculiarities that differentiate it from 
the typical characteristics of the species. The 
varieties are therefore named in accordance with 
the particular specific properties of the affections 
of the organs of an apparatus. 

9. Sub-varieties. — A sub-variety is a subordinate 
variety or a division of a variety. It may indi- 
cate morbid properties differing in their charac- 
teristics from those typical of varieties, or may 



* Variety, from varius which probably comes from varus a 
speck or speckle, because this is the best emblem of variety. 
Variety seems to lie in the things themselves. A variety can- 
not exist without an assemblage. Variety strikes on the 
mind, and pleases the imagination with many agreeable 
images ; it is opposed to dull uniformity*' (Crabb.) 



TERMS OF CLASSIFICATION. 25 I 

indicate the special cause of the affection. The 
sub-varieties, therefore, relate partly to the spe- 
cial character and partly to the aetiology of the 
affections of the organs of an apparatus. 

10. Symptoms.* — A symptom is a manifestation 
of disease. It is perceptible to the senses, even 
of the patient. 

11. Signs. — The sign of a disease is the indica- 
tion of its presence. It may be (1,) a sign per se, 
indicating disease apart from symptoms, or (2,) 
an inferential sign deduced from the analysis of a 
symptom or of a group of symptoms. 

The symptoms and signs, without which ac- 
curate classification would be impossible, serve to 
detect individual diseases and establish species, 
and from the species the classification is con- 
structed, for out of them spring the genera and 
the orders, the varieties and the sub-varieties. 
Therefore the position of symptoms and signs is 
next in order to the fundation stone of no- 
sography. 

Symptoms of diseases, being their manifesta- 
tions or those phenomena which are apparent to 
the senses of the observer or even of the patient, 



* Symptom, from 6vv, with, and itiiCTEtv, to fall. To fall 
in with. Any perceptible change in the human body. 



252 TERMS OF CLASSIFICATION. 

differ very materially from the signs, these being 
deduced from the analysis of the symptoms. 
Therefore the symptoms are noticeable by any- 
body, but unless rightly interpreted are generally 
of little value. It is only the wise and experi- 
enced physician, after analyzing a group of symp- 
toms and properly interpreting them, who can 
perceive what is correctly termed the sign of a 
disease.* 



* The following note is paraphrased from Double's " Seme- 
iologie Generate. A collection of symptoms properly analyzed 
becomes the sign of a disease. The sign is a conclusion 
which the mind draws from the symptoms thus analyzed. 
Therefore the sign belongs to the understanding and the 
symptom to the senses. The sign of a disease may exist with- 
out symptoms. It is said by Fernel that all symptoms are 
signs but that all signs are not symptoms. Symptoms are 
observed only in disease, but there are signs which belong to 
health. It is not generally said that a man shows symptoms 
of health, but that he shows signs of health. 



253 



SECTION V. 

REVIEW OF THE MORBID STATES AND MORBIFIC 

PROCESSES. THE BACTERIA, PTOMAINES, 

LEUCOMAINES, AND EXTRACTIVES. 

Analysis of some of the terms used in general pathology 
and of those contained in the synopsis of morbid states and 
morbific processes, together with remarks on these states 
and processes. Summary of the present state of knowl- 
edge of the bacteria, ptomaines, leucomaines, and "extrac- 
tives." The relations borne, to medicine and surgery, by these 
microorganisms and alkaloids of putridity. Classifications of 
the bacteria, ptomaines and leucomaines. Uniformity in their 
nomenclature and classification much needed. Remarks on 
the neoplasms and on their classification. 

As already stated, the synopsis of morbid 
states and morbific processes is intended as a 
suggestion of a ground-work for the classification 
of diseases, but inasmuch as new terms are 
therein proffered, and changes, tending to greater 
precision, made in many of those that are in 
general use, some explanation is due respecting 
the nature of the new words and the foundation 
of the changes in the old terms. Therefore most 
of the terms contained in the synopsis will now 
be defined, analyzed and, as far as practicable, 
reasons given for their introduction. 



254 ALTERATIONS OF THE BLOOD. 

In this attempt to correct defective words and 
to coin new terms, prefixes and terminals which 
are in general use will be employed, such as 
hyper which signifies over, above, excess, and will 
be applied in the sense of increase, and hypo 
which signifies under, below, and will be applied 
in the sense of decrease. The terminal aemia, 
from ai'jua, blood, will be employed in preference 
to osis so often improperly used in that connec- 
tion. The middle section of each term com- 
pounded of three roots will also be explained and 
its etymology given in a foot note. 

I. ALTERATIONS IN THE QUANTITY, QUALITY, 
AND COMPOSITION OF THE BLOOD. 

i. Hyperaemia* is here used in its strict signi- 
fication of a superabundance of blood, an in- 
crease of its whole quantity in the body, and 
is offered to replace "plethora vera" poly- 
aemia, and hyperaematosis. Hyperaemia has 
often been wrongly employed to signify local 
congestion or the accumulation of blood in the 
capillary vessels, or even inflammation. In the 
Lexicon of Medicine, etc., of the New Sydenham 
Society, London 1886, hyperaemia is defined as 



* vizip, over, above, excess, and aipia, blood. Above the 
normal amount of blood. 



ALTERATIONS OF THE BLOOD. 25 $ 

11 an excessive amount of blood in the vessels of a 
part ; a local overfilling of the blood-vessels, so 
that they are distended with blood and give more 
or less increased redness to the part, with some 
swelling. When hyperaemia continues there 
may be oedema of the part from effusion of 
serum, or there may be haemorrhage." There is 
nothing in this definition, or rather description,, 
to indicate general overplus of blood. It is, in 
reality, a definition of congestion whose proper 
place is under the caption of disturbances in the- 
circulatory apparatus. 

2. Hypoaemia,* meaning an insufficiency of 
blood, a decrease of its whole quantity in the 
body, is introduced in place of anaemia which 
literally signifies absence of blood. The inten- 
tion in the coinage of the word anaemia was to 
express the idea of a lessening of the red blood 
cells, and it has failed to do so. The privative 
alpha in this, and in many other words to which 
it is affixed, leading to misconception of the con- 
dition intended to be designated. Therefore 
all words so prefixed should be rejected, except 
where the a is absolutely needed, as in atrophy \ 
when cessation of nutrition is intended to be ex- 



* From i7to t under, beneath, below, and ai'/iac, blood. Be- 
low the normal amount of blood. 



256 ALTERATIONS OF THE BLOOD. 

pressed, and in local anaemia when there is 
literally no blood in the capillary vessels of a 
part; e. g., local capillary anaemia caused by 
ischaemia arising from constriction of the capil- 
laries, the plugging of a neighboring arteriole, 
etc. 

The term hypoaemia was formerly used to in- 
dicate the presence of blood in the anterior 
chamber of the eye, although there is not a sylla- 
ble in this word to show that it has reference to 
the eye. Hypoaemia was also used synonym- 
ously with ecchymosis, sugillatio. " Anaemia, 
used (by the French) synonymously with oligaemia, 
is a want, or deficiency of blood ; the condition 
of the body after great loss of blood ; exsan- 
guinity. There may either be a defect in the to- 
tal quantity of blood, as occurs for a short time, 
perhaps, after profuse haemorrhages, or a dimi- 
nution in the relative amount of red corpuscles 
as compared with the other constituents of the 
fluid, as in chlorosis." * 

This mixed definition, not of anaemia, but of 
hypoaemia, hypoerythrocythaemia, hyperhy- 
draemia and hypohydraemia, is very confused 
and confusing. 



* Lexicon of Medicine, etc. New Sydenham Society. 



ALTERATIONS OF THE BLOOD. 257 

3. Hyperhydraemia* signifies increase of blood- 
water which is not indicated by the commonly 
used word hydraemia whose meaning is simply 
blood-water, although it has been defined, by 
high authorities, " as a watery condition of the 
blood depending on defect of albumen and fibrin, 
or on retention of water from arrest of the cu- 
taneous or renal secretions." 

Hyperhydraemia is the outcome, of profuse 
haemorrhage, exhausting diseases, or starvation. 

4. Hypohydraemia signifies decrease of blood- 
water, and is the outcome of those diseases in 
which much water is consumed in, or discharged 
from, the body, as in cholera, erysipelas, acute 
articular rheumatism, puerperal fever, typhus 
and typhoid fevers, conditions producing poly- 
uria, etc. 

To express the idea of deficiency of serum in 
the blood, Piorry adopted the term anhydraemia 
which means absence of blood-water and is there- 
fore inexact. 

5. Hyperinosaemiaf signifies increase in the 
tendency to the formation of blood-fibrin, while 
hyperinosis indicates " over activity of muscular 
fibre." The term hyperinosis was suggested by 



* vdoap, water. 

+ vitep, excess, i'S, i'rof, muscle, fibre, and ai'/ia } blood. 



258 ALTERATIONS OF THE BLOOD. 

F. Simon to express the idea of " excess of fibrin 
in the blood ; such as occurs in acute rheuma- 
tism and in erysipelas, when it may amount to 
upwards of one per cent." But this, like many 
other imperfectly constructed terms, fails to con- 
vey the intended idea, unless the final is be re- 
placed by aemia, 

6. Hypoinosaemia signifies decrease in the 
tendency to the formation of blood-fibrin. Flint* 
uses the term hypinosis to signify imperfect 
coagulation of the blood, but it really means de- 
creased activity of muscular fibre. 

Hypoinosaemia appears to be the more exact 
term. " It has been observed in some acute 
infectious diseases, in acute icterus, in death 
from asphyxia, and in death from certain poisons, 
such as sulphuretted hydrogen and hydrocyanic 
acid." 

7. Hyperleucontaemia signifies increase of 
blood-albumen, f There being no Greek word 
for albumen, the term leucontaemia is offered to 
signify blood-albumen, from \bvx6y, white of egg, 
which is albumen. 



* A. Flint, Principles and Practice of Medicine. 1886. 
t The substance formerly called albumen of the blood is in 
reality serine and metalbumen. {Flint's Physiology.) 



ALTERATIONS OF THE BLOOD. 259 

8. Hypoleucontaemia signifies decrease of 
blood-albumen. Hypoalbuminosis, a hybrid word 
and therefore inadmissible, has been used to 
designate a deficiency of albumen in the blood. 
A condition existing in starvation or after a co- 
pious haemorrhage. 

9. Hyperalonaemia * signifies increase of blood- 
salts. 

10. Hypoalonaemia signifies decrease of blood- 
salts. These alterations in the quantity of the 
saline elements of the blood play an important 
part in diseases. 

11. Hyperchromataemia f signifies increase of 
blood-color. The coloring matter of the red 
corpuscles of the blood is called haemaglobine 
which is a hybrid word. It is sometimes dif- 
fused in the blood owing to disintegration of the 
red corpuscles, and thus the blood is increased in 
color. The term haemoglobinaemia is used to- 
designate this condition, but its composition ren- 
ders it hybrid as well as tautological. It is taken 
from ai'/ioc, blood, globulus, globule, and the term- 
inal ai/xa, blood. Hyperchromataemia seems to- 
indicate clearly an increase in the blood-color. It 



* vitepi increase, aAS, aXcov (genitive plural), salt salts, 
and at'jua, blood. 
f xprijuoc, color. 



260 ALTERATIONS OF THE BLOOD. 

is for the pathoanatomist and clinician to de- 
termine and interpret its causes and effects. 

12. Hypochromataemia signifies decrease of 
blood-color. As there is increase, so, in all prob- 
ability, many circumstances arise to cause a de- 
crease in the color of the blood. 

13. Hyperleucocythaemia signifies increase of 
white blood-ceils. Leucocythaemia* is the term 
ordinarily used, but it only means white blood- 
cells, and expresses a normal condition. The 
other terms, leucocytosis and lukaemia, sug- 
gested by Virchow are quite as indefinite ; the 
latter meaning white blood, which is lymph- 
This eminent pathoanatomist adopts the word 
leucocytosis to express the idea of a temporary 
increase in the number of white corpuscles, but 
the term entirely fails to convey such an idea. 
In the case of a great and permanent increase of 
white blood-cells he uses leucocythaemia or 
lukaemia, both equally misleading. 

In hyperleucocythaemia, the red blood-cells 
are generally decreased in number, so that the 
two conditions hyperleucocythaemia and hy- 
poerythrocythaemia occur in conjunction. 

Hypoxanthine has been found in considerable 



* Xevuoiy white, hv6ti$, pouch, bag, — cell. 



ALTERATIONS OF THE BLOOD. 261 

quantity in cases of hyperleucocythaemia. 
(Gamgee,) 

14. Hypoleucocythaemia signifies decrease of 
white blood-cells. 

15. Hypererythrocythaemia* signifies increase 
ot red blood-cells. Plethora,f plerosis, — meaning 
repletion, and intended to mean a superabund- 
ance of blood in the system but failing to do so ; 
hence the division of plethora into general and 
local, — hyperaemia, polyaemia, polycythaemia, 
polyhyperaemia (!), angioplerosis, erythraemia 
(red blood), have all been used, improperly of 
course, to designate increase of red blood-cells. 

16. Hypoerythrocythaemia signifies decrease 
of red blood-cells. Anaemia is generally, and im- 
properly, used to express this condition. An- 
aemia literally means absence of blood, and 
should be restricted to the expression of the idea 
of local absence of blood, — local anaemia, — such 
as occurs in ischaemia which may be a temporary 
or a permanent arrest of blood in a part, the lat- 
ter arising from constriction of the capillaries, 
from plugging of a neighboring arteriole, or 
from some other cause. 



* epvBpoS, red. 

t Plethora, from xXrjBoS, a great number. 



262 ALTERATIONS OF THE BLOOD. 

17. Hyperlipaemia signifies increase of blood- 
fat, and is generally called lipaemia (blood-fat), a 
normal condition which is very variable in the 
blood-plasma. It increases after the ingestion of 
fatty substances until the blood may acquire a 
milky appearance. Fat has been known to in- 
crease in the blood of diabetics, in certain affec- 
tions of the liver, in phthisis, in chronic alcohol- 
ism, and in fat embolism. 

18. Hypolipaemia signifies decrease of blood- 
fat. 

19. Hyperphysaemia signifies increase of blood- 
gas. The gases which exist normally in the 
blood are carbon dioxyde, oxygen, and nitrogen, 
either in solution, or in combination with organic 
or inorganic compounds. Their increase gives 
rise to abnormal states which will not here be 
discussed. The reader is therefore referred for 
further information on this interesting subject to 
Paul Bert's experiments, and to works on general 
pathology in which are found articles on the ef- 
fects of high atmospheric pressure, air embolism, 
etc. 

20. Hypophysaemia signifies decrease of blood- 
gas. The ill effects of this condition are fully 
treated of in the works to which allusion has 
been made above. But a word may be said in 



ALTERATIONS OF THE BLOOD. 263 

reference to the effects of rarefaction of the at- 
mosphere on the respiration and on the blood, 
such as are felt during the ascent of high moun- 
tains. The name of the " mountain disease or 
anoxyaemia" has been given to the condition of 
individuals who, thus breathing an insufficient 
amount of oxygen, take more but shorter inspira- 
tions than normally, suffer head-ache, epistaxis 
and other haemorrhages, and are soon overcome 
by fatigue, cold, sleep, and in some cases by 
death. The same phenomena occur during 
baloon ascensions. A notable instance is re- 
corded by Tissandier, sole survivor of three who 
had ascended to a great height in the baloon 
Zenith.* Jourdanet has published an interesting 
work, in two volumes, upon the influence of at- 
mospheric pressure on the life of man, based 
upon a long experience and many observations 
made principally in Mexico.f 

21. Hyperglycaemia signifies increase of blood- 
sugar. Glycaemia, blood-sugar, is a normal con- 
dition. It is only when the sugar exceeds in 
amount two parts and a half in one thousand of 
blood that it causes any disturbance.. It then 

* Academie cles Sciences 25 Avril 1875, La relation de M. 
G. Tissandier, seul survivant. 

t Sur l'influence de la pression de l'air sur la vie de 1'homme* 
Paris 1875. 



264 ALTERATIONS OF THE BLOOD. 

shows itself in the urine and constitutes what is 
known as glycosuria. It arises from the disas- 
similation of certain alimentary substances. 

22. Hypoglycaemia signifies decrease of blood- 
sugar. 

23. Acetonaemia signifies acetone in the blood. 
That acetone is found in the blood in connection 
with disease is not doubted, but its exact import 
is still unsettled. On the other hand it has been 
asserted that " acetone is a normal product of 
tissue metamorphosis." 

24. Ammoniaemia signifies ammonia in the 
blood. Ammonium carbonate is formed in stag- 
nant, decomposed urine in the pelves of the kid- 
neys or in the bladder, and absorbed and carried 
into the circulation, or may be absorbed from the 
intestines. In cases of stagnation of urine in the 
bladder, a bacterial ferment is said to have been 
discovered which possesses the property of con- 
verting urea into ammonium carbonate. 

This ferment is often introduced from without 
through the use of unclean catheters. 

"It was suggested by Frierichs, in 1852, that 
uraemic phenomena are due to the conversion of 
urea into ammonium carbonate in the blood, but 
there is no ground for believing that such conver- 
sion actually occurs during life." (Gamgee.) 



ALTERATIONS OF THE BLOOD. 265 

25. Hyperuraemia signifies increase of blood- 
urea. Uraemia means blood-urea, but it is 
generally used in the sense of accumulation in 
the blood of the elements of the urine. May 
not the group of phenomena called urinary in- 
toxication be due to the accumulation in the 
blood, of acetone together with ammonium car- 
bonate, urea, and other deleterious excrementi- 
tious substances, such as the "extractives"? 

In an experimental study of the poisonous prop- 
erties of the urine of different animals, Charrin 
concludes " that the urea is not the toxic agent 
of the urine." 

Hyperuraemia indicates the increase of a nor- 
mal constituent of the blood (urea). 

26. Hypouraemia signifies decrease of blood- 
urea. 

27. Hyperuricaemia signifies increase of blood- 
uric acid. Flint first suggested the term uric- 
aemia which simply means blood-uric acid, and 
Murchison adopted the word lithaemia (from 
XiQos, stone), stone in the blood, meaning uric 
acid in the blood which is a normal condition. 

A great increase of uric acid in the blood has 
been observed by Garrod in the disease called 
gout. 



266 ALTERATIONS OF THE BLOOD. 

28. Hypouricaemia signifies decrease of blood- 
uric acid. 

29. Cholaemia signifies bile in the blood. In 
morbid conditions where the exit of the bile from 
the liver is impeded, the bile is absorbed by the 
lymphatics and carried into the circulation. The 
constituents of the bile creating certain toxic ef- 
fects, and the bilirubin staining most of the tis- 
sues of the body and producing the condition 
known as icterus or jaundice. 

30. Hypercholesteraemia signifies increase of 
blood-cholesterin. Flint jr. asserted, in 1862, 
" that the cholesterin of bile is a result of an ex- 
cretory function of the liver not previously 
recognised, and that it is an excrementitious 
principle derived chiefly from the disassimilation 
of nervous tissue," and has given the name of 
cholesteraemia to the accumulation of cholesterin 
in the blood. He attributes grave toxic effects 
to such accumulation. Up to the present date 
Doctor Flint holds the same opinion on this sub- 
ject. Some of the French, English and German 
writers take issue with Doctor Flint in his view 
that hypercholesteraemia is capable of producing 
the toxic effects attributed to " grave-jaundice." 

31. Hypocholesteraemia signifies decrease of 
blood-cholesterin. 



SEPTICAEMIA, PTOMAINES. 267 

32. Melanaemia signifies black pigment in the 
blood. The different views respecting the pro- 
duction of this condition will not here be dis- 
cussed. The reader is therefore referred to works 
on general pathology.* 

33. Septicaemia f signifies putrid infection of 
the blood. This is due to infection of the blood 
with the poisons of putrefied animal substances. 
These animal poisons are now known to be 
alkaloidal, and are named ptomaines, from itrcsofia, 
cadaver, and iv 3 in, er, within, opposed, to en 
without. The terminal in, or ine, is ordinarily 
employed by chemists to designate alcaloids. 
There is nothing in this etymology to denote an 
alkaloid, therefore ptomaine is not a word of 
precision.;); 

The ptomaines may be evolved in severely in- 
jured parts of the human body followed by rapid 
decomposition, before suppuration takes place, 
or in blood effused in the great cavities of the 

* There are other changes in the constituents of the blood, 
but they are not sufficiently well known to be here considered. 

t From (j?77rroS, putrid, and ai'jua, blood. 

I Selmi derives ptomaine " from 7trc*)/ta, a carcase, a dead 
body, and ivo, denoting material ; or in, from the Latin inus 
belonging to." But ivo does not seem to mean material, and 
even if it should have such a signification, material is too ob- 
scure to designate alkaloid. 



268 PTOMAINES. 

body such as the pleura or peritoneum, or may 
be ingested with food, and thus be absorbed and 
infect the blood. 

They are called ptomaines because of their 
original discovery in putrid cadavers. 

As some of the readers of this work may de- 
sire to study the subject more extendedly than it 
can be here presented, only a brief account, with 
some references, will be given of the discovery 
of ptomaines, and of the investigations, of their 
nature, toxic properties, and mode of develop- 
ment, now going on in Europe and America. 

Discovery, in medicine, is generally slow and 
gradual, and results from the labors of many 
men. The first discoverer may only observe the 
effect, another finds the cause, still another dis- 
covers the generic substance and perhaps its 
properties, then investigators arise who discover 
species and varieties, and finally come those 
practical men who are able to interpret the 
phenomena directly or indirectly connected with 
them and from their analysis of these phenomena 
deduce the remedial means to be taken. 

Ptomaines* — The history of the discovery of 



* Doctor A. M. Brown defines a ptomaine, " considered 
from a purely chemical point of view, as the cyclical nucleus 
of a proteid molecule that has undergone complete destruc- 
tion in the process of putrefaction." 



PTOMAINES. 269 

ptomaines is a notable illustration of the forego- 
ing statement. In 1822 Gaspard, and in 1856, 
Professor Panum, of Copenhagen, found putrid 
substances to contain active poisons the nature of 
which they could not ascertain. In 1868, Berg- 
mann and Schmiedeberg believed that they found 
in contaminated blood a crystallizable nitrogenous 
substance, which they called sepsine and which 
they had found in putrid yeast. Their discovery 
was contested. In 1869, Zeulzer and Sonnen- 
schein are said to have obtained from putrescent 
animal matter an alkaloid having the properties 
of atropia. Rosch and Fassbender also found, in 
putrescent animal matter, an amorphous salt giv- 
ing reactions similar to those of digitaline. Dupre 
and Bence Jones extracted, from the liver, a salt, 
giving the fluorescence of sulphate of quinia, 
which they named animal chinoidine. 

Professor Armand Gautier, of Paris, found, in 
1872, that, while undergoing putrefaction, the 
fibrin of the blood gave a small quantity of com- 
plex alkaloids, fixed and volatile. The late Pro- 
fessor Selmi, of Bologna (1870, -75, -78, -80) ar- 
rived at similar results in his experiments with 
putrefied human tissues, and announced that un- 
der these conditions, toxic organic alkalies, 
analogous to vegetable alkalies, were formed. 
Since then these substances have been studied, 



270 PTOMAINES. 

especially by Gianetti and Corona (1880), Brouar- 
del and Boutmy (1881), Bouchard (1882-3), Gau- 
tier and Etard (1886), and Brieger (1886). 

Nencki (1876) appears to have been the first to 
indicate the chemical formula of a ptomaine. 

Gautier divides the animal alkaloids into two 
distinct groups, ptomaines and leucomaines* The 
first are the products of organic matter in putre- 
faction, the second, of the living organism in 
health and in disease. 

Ptomaines vary in different phases of putrefac- 
tion. Brieger has found successively in the dead 
human body ; choline, neuridine, cadaverine, pu- 
trescine, trimethylamine, and mydaleine. Besides 
the above, Gautier enumerates the following 
ptomaines ; parvoline, hydrocollidine y collidine } and 
saprine. 

These alkaloids are evolved through microbic 
fermentation generally after death ; but are more 
or less toxic when ingested with food. 

In a recent article, Professor Vaughan, of the 
University of Michigan, divides the ptomaines 
into two classes ; (1,) those containing oxygen : 
(2,) those containing no oxygen. " Among the 



* Gautier gave to the alkaloids of the human organism the 
name of leucomaines " to indicate their albumenoid origin." 



PTOMAINES. 27I 

most important members of the second class are 
the following : 

1. " Collidine — C* Hn N, discovered by Nencki 
in 1876, in gelatine allowed to putrefy with infu- 
sion of pancreas. 

2. " Parvoline — C B Hi 3 N, discovered by Gau- 
tier in 1 881, as a product of the putrefaction of 
fish. Parvoline is an oily base, of amber color 
and boils at 200 C. It is slowly soluble in wa- 
ter, freely soluble in ether, alcohol and chloro- 
form. 

3. " Hydrocollidine — Ce His N, discovered by 
Gautier and Etard in 1882, also from putrid fish. 
It is an oily liquid, boiling lit 210 C. It is very 
poisonous, seven milligrammes being sufficient 
to kill a pigeon. Death is preceded by nervous 
excitement and tetanic convulsions. 

4. "Base — C17 H 38 N«, discovered by Gautier 
and Etard in 1882. It is not poisonous. 

5. " Base — C10 Hi N, discovered by Guareschi 
and Mosso in 1883, in putrid beef. It is not 
poisonous, or is so only in very large quantity. 

6. " Neuridine — C» Hn Ni, discovered by 
Brieger in 1884. It is wholly inert, and its im- 
portance depends upon its presence in nearly all 
putrid matter and upon the fact that it gives all 



272 PTOMAINES. 

the general alkaloidal reactions, and for this 
reason may be mistaken for some vegetable 
poison by the toxicologist. 

7. " Tyrotoxicon* — C« Hs Na, discovered by 
Vaughan in 1885, in poisonous cheese, and found 
by himself and others later in milk, ice cream, 
custard, cream puffs, etc. This is a highly poison- 
ous body, producing nausea, vomiting, collapse 
and death. 

8. " Cadaverine — Cs Hi« N a , discovered by 
Brieger in the cadaver. It is inert. 

9. " Putre seine — C* H 12 N 2 , also discovered by 
Brieger, is not poisonous. 

10. u Mydaleine. — The chemical composition of 
this ptomaine has not been determined. It di- 
lates the pupils and elevates the temperature 
from i° to 2 when injected under the skin. 

" Among the oxygen containing ptomaines, the 
most important are : 

1. " Neurine — Cs His NO, contracts the pupil, 
lessens the respirations, hastens the action of the 
heart, causes profuse diarrhoea and the involun- 
tary emission of urine. 



* See the Report of Doctor Vaughan to the Michigan State 
Board of Health for 1885. 

According to Gautier putrid cheese yields neuridine. 



PTOMAINES. 273 

2. " Choline — C» Hi* NO2, is found in small 
quantity in the bile as well as in putrid matter. 
It is less powerful in action than neurine, which 
it resembles. 

3. " Gadinine — O Hi 8 NO, discovered by 
Brieger, is not poisonous." 

Doctor A. M. Brown* arranges the ptomaines 
into " two classes, the non-oxygenous and oxy- 
genous. The first come from the pyridic bases 
of Gautier, or those ptomaines which, besides be- 
ing the most abundant, persist throughout the 
whole of the putrefactive process." 

" NON-OXYGENOUS ALKALOIDS. 

i. " Parvoline, C 9 Hi 3 N. — This was the first 
ptomaine chemically analysed and defined. It 
was discovered by Gautier and Etard in the 
putrefactive products of the mackerel and horse 

flesh It is described by them as an oily 

base 

2. " Hydro-Collidine, C« H 3 N. — This base has 
also been obtained from the putrefactive pro- 
ducts of the mackerel and horse, and even ox 



* A treatise on the animal alkaloids, cadaveric and vital ; or 
the ptomaines and leucomaines, etc. London, 1887, p. 31 
et seq. 



274 PTOMAINES. 

flesh it is very poisonous, even in very small 

quantities. 

3. "Base, C17 Hss N*. — The analysis 

which Gautier and Etard have made of this 
chloroplatinate enables them to establish the 
formula G* H 13 N* 2 H CI. 

4. " Base, C10 His N. — This ptomaine was dis- 
covered in 1883, by Guareschi and Mosso, who 
isolated it by the Gautier-Etard method from the 

putrid fibrine of the bullock It has also 

been detected among the basic products arising 
from the putrefaction of cephalopod pulps 

5. " Collidine, Cs H,i N. — Was extracted by 
Nencki, in 1876, from the putrefactive products 

of gelatine and of bullock pancreas, 

{mixed with water) 

6. " Neuridine, C& H14 Na. — This base is one of 
the most constant products of the putrefaction of 
albumenoid substance. The ptomaine was dis- 
covered in 1884 by Brieger, who has since de- 
tected it in the putrescent matters of flesh, fish, 

decaying cheese, etc Chemically pure 

neuridine is not toxic. 

7. " Cadaverine, C* Hi« Na. — In bodies subjected 
to prolonged putrefaction, Brieger has met with 
a base of very difficult purification, to which he 
has given the name of cadaverine. Boeckersh 



PTOMAINES. 275 

has separated it from herring brine, and quite re- 
cently — 1884 — the alkaloid has been detected in 
marine cephalopod pulp. The ptomaine is not 
toxic. 

8. " Putrescine, C* Hu Na. — Like the preceding 
ptomaines, it is obtained from the flesh of the 
mammifera, and from herring brines. It is not 
toxic. 

9. " Mydaleine. — In the mother liquors from 
which the preceding bases have been isolated 
owing to the varying solubility of their platini- 
chlorides, there remains a toxic alkaloid which 
has also been isolated, but in too small quantities 
to permit of its complete study. The analysis of 
it is suggestive of a diamine similar to those we 
have been dealing with 

"OXYGENOUS ALKALOIDS. 

11 These bases serve as the connecting link be- 
tween the ptomaines and the leucomaines. With 
the exception of gadinine they are to be met with 
in the normal tissues as well as in putrescent 
animal materials. 

(C H.) \ 
I. " Neurine, C 6 H ia N (O H)= N O H. 

C a H 3 / 

" Hydrate of trimethylvinylammonium. 



276 PTOMAINES. 

" It is known that the breaking up of a complex 
compound with a watery solution of baryta, the 
lecithine present in the animal economy, by tak- 
ing up or fixing the water, furnishes besides 
phosphoglyceric and stearic acids, and a base 
choline Ce His NO2 the synthesis of which 
Wurtz effected in treating trimethylamine with 
oxyde of ethylene in the presence of water 

C H 2 \ (C H 3 ) 3 x 

0+ (C H 3 ) 3 N + H 2 0= N. O H 

C H 2 / C a H 4 O H / 

" This synthesis characterises choline as the 
hydrate of trimethylhydroxethylene — ammon- 
ium. Treated with hydriodic acid, choline is 
converted into an iodide of iodethylene-trimythyl- 
ammonium 

(C H 3 ) 3 x (CH,),\ 

N. 0H + 2HI = 2H20+ N I. 

C 2 H 4 O H / C a H 4 I / 

" The oxyde of silver transforms this latter 
body into a new base neurine which is a hydrate 
of trimethylvinylammonium 

(C H 9 ) 3 v (C H 3 ) 3 \ 

N. I + Ag 2 O = 2 Ag I + N. O H. 

C 2 H 4 I / C a H 3 / 

" This is the neurine that has been met with by 
Brieger in the products of cadaveric putrefac- 



PTOMAINES. 277 

tion, when it arises from the breaking up of 
lecithine. It is a syrupy base soluble in water in 
any proportion, strongly alkaline ; its chloro- 
platinate well crystallised may be removed from 
the mother liquors of the neuridine. This base 
is toxically interesting. 

(C H 3 ) 3 \ 
2. " Choline, C 6 H 1B N O a = N. O H. 

C 8 H<— O H / 

Hydrate of trimethylhydroxethylenine — am- 
monium. 

11 It is Strieker who has isolated this body from 
the bile. It is distinguished from neurine by the 
composition and formula of constitution as given 
above. The choline is a base which is elaborated 
both during normal life of the tissues, and during 
their bacterial destruction, and is therefore, both 
ptomaine and leucomaine. Brieger has isolated 
it by crystallising in the form of picrate of choline 
in the mother liquors from which he derives the 
neurine 

Choline is less toxic than neurine. 

3. " Muscarine, Co His N O t , was discovered by 
Schmiedeberg and Koppe in the toadstool — 
agaricus muscarius. Schmiedeberg and Hartnack 
have accomplished its synthesis by oxydising 



278 PTOMAINES. 

choline with nitric acid ; this permits muscarine 
to be regarded as an aldehydic alkaloid. 

(C H 3 )a X 

N O H. 
C 2 H 3 O • 

" Brieger has isolated it along with ethylene- 
diamine in putrid fish meat. Muscarine is found 
present in the mother liquors, in which the 
chloride of platinum has precipitated the ethy- 
lene-diamine 

Muscarine is a violent poison. 

4. " Gadinine, & Hi« N O2. — Brieger obtains 
this body at the same time and along with the 
preceding base from the cod-fish — gadus callarius 
— in process of putrefaction. This alkaloid has 

not been isolated in a free state Its salts 

are not toxic. 

5 and 6. Bases, C* Hi* N* 0«, and C* H 19 N* 0<. 
— Pouchet has published since 1880, quite a 
series of interesting works on the ptomaines. He 
endeavours to isolate by a somewhat similar 
method to that of Stas and Drugendorff, the 
alkaloids of the residuary liquors resulting from 
its industrial treatment of bones, flesh, and de'bris 
of every kind, by dilute sulphuric acid 

" In the course of his researches, Brieger has 
detected other alkaloids still less defined or 



PTOMAINES. 279^ 

simply indicated, which are having now his care- 
ful study " 

brieger's nomenclature. 

The following table is arranged after Brieger's 
nomenclature; the several ptomaines occupy the 
relative positions in which they appear in the 
French translation of his work.* 

I. Ptomaine of peptone. 
I. Peptoxine. 

II. Ptomaines of putrefied meat. 

1. Neuridine 

2. Neurine 

3. Choline. 

III. Ptomaines of putrefied fish. 

1. Ethylene-diamine 

2. Animal muscarine 

3. Gadinine 

4. Triethylamine. 

IV. Ptomaines of putrefied cheese. 

1. Neuridine 

2. Trimethylamine : 



* L. Brieger, Microbes, ptomaines et maladies. Ouvrage 
tradnit de l'Allemand par les Docteurs Roussy et Winter- 
Paris, 1887. 



280 PTOMAINES. 

V. Ptomaines of putrefied gelatine. 

1. Isophenyl-ethylamine of Nencki. 

2. Neuridine of gelatine 

3. Dimethylamine. 

VI. Ptomaine of putrid yeast. 
1. Dimethylamine of yeast. 

VII. Ptomaines of the human cadaver. 

1. Choline 

2. Neuridine 

3. Cadaver ine 

4. Putre seine 

5. Saprine 

6. Trimethylamine 

7. Mydaleine. 

When putrefaction occurs at a low tempera- 
ture the toxic alkaloids are developed slowly, and 
vice-versa. 

In the different states of putrefaction of human 
cadavers, Brieger has found ptomaines which 
disappear to be replaced by others. Lecithine, 
which exists normally, is followed by choline, 
then other alkaloids are elaborated. On the 
second day neuridine, which is accompanied by 
choline, is found. The choline soon begins to 
disappear in favor of trimethylamine. The neurid- 
ine then increases; the greater quantity being 



PTOMAINES. 28l 

furnished by the intestines, the large parenchy- 
matous organs containing but little of this salt. 
On the seventh day of putrefaction the choline 
disappears while the neuridine lasts until the 
fourteenth day. For two days after the beginning 
of putrefaction there is no poison as the first two 
alkaloids are not toxic. Cadaverine increases dur- 
ing the whole process of putrefaction. With 
cadaverine, putrescine and saprine are ordinarily 
found. Choline and trimethylamine are not toxic 
except in large quantity. The really strong 
poisons are not developed until fifteen days from 
the beginning of putrefaction. Mydaleine is not 
developed until three weeks. It is the most toxic 
of all the alkaloids. Injected in small quantity into 
guinea-pigs and rabbits, it causes inflammation of 
the mucous membranes, dilatation of the pupils, 
and increase of the body temperature. An injec- 
tion containing half a centigramme of mydaleine 
caused the sudden death of a cat. It gives rise to 
profuse diarrhoea and vomiting. (Gautier). 

Nicati and Rietsch have obtained, from pure 
cultures of the cholera bacillus, a ptomaine 
which, they say, produces symptoms of cholera 
when injected into the body of an animal. 

Gautier says that the typhoid fever bacillus of 
Eberth does not cause putrefaction, but that the 
liquids in which it has lived contain a trace of a 



282 PTOMAINES. 

base which possesses the property of dilating the 
pupils, and causes diarrhoea, and very soon 
death. 

From cultures of the tetanus bacillus, growing 
in connection with a non-pathogenic organism 
from which it has not yet been freed in pure cul- 
tures, Brieger has separated a ptomaine which he 
calls tetanin, and which, injected hypodermically, 
produces, in animals, symptoms similar to those 
induced by inoculation with the organisms them- 
selves, namely symptoms of tetanus.* (Com- 
municated by Doctor Prudden). 

Brieger has " obtained from mussels, (i,) a non- 
poisonous substance; (2,) a substance which is 
isolated by means of platinum chloride, and 
which produces energetic salivation and diar- 
rhoea ; (3,) the specific virus, which combines 
only with the tetrahedral platinum chloride. It 
possesses the characteristic properties of curare ; 
(4,) an analogous body, probably a decomposi- 
tion-product. It is an energetic poison and occa- 
sions shiverings. Non-poisonous mussels, if 
brought in from the offing and deposited in the 
harbor, become poisonous, but lose this property 
again if returned to the open sea. (Is the de- 
velopment of the poisonous principles occasioned 



* Deutsche Med. Wohenschr. Apl. 14th, 1887, p. 303. 



PTOMAINES. 28$ 

by the mussels feeding npon sewage-matters?"*} 

Carles has discovered in decayed salt cod-fish a 
red micrococcus, and describes the condition un- 
der the name of red stock-fish. 

Gautier asserts that putrid fish yields a poison: 
which has the same composition and action 
as muscarine. 

Gautier desiring to ascertain if the saliva of the 
higher orders of animals contains a poison similar 
to the venom of serpents, found, in the saliva of 
man a toxic alkaloid which narcotises birds. This 
alkaloid, he says, resembles cadaveric alkaloids, 
is soluble in water, is not an albumenoid and is in- 
destructible by a heat of 212 . 

The study of ptomaines is of very great im- 
portance alike in chemistry, pathology and legal 
medicine. Particularly in the last named depart- 
ment of medicine, when it is considered that 
most of the ptomaines are liable to be mistaken 
for such vegetable alkaloids as strychnia, vera- 
tria, nicotia, hyoscyamia, atropia, etc. 

The body of a man who has died from the ef- 
fects of a poison does not contain ptomaines until 
decomposition has been fairly established, but the 
ptomaines are found under the same condition of 



* Chemical News, June 1 886. 



284 PTOMAINES. 

putrefaction when the cause of death is other 
than poison. 

Doctors Brouardel and Boutmy report that 
having analyzed the viscera " of a person asphyx- 
iated by charcoal fumes, they found them free 
from poison. Eight days later the same viscera 
were again subjected to analysis and found to 
contain a solid organic base presenting the gen- 
eral characteristics of alkaloids, and toxic enough 
to kill, even in small doses, frogs and guinea pigs. 
This shows that putrefaction gives rise to organic 
alkaloids when no poisoning has taken place." 

On another occasion they " found a venenous 
ptomaine in a subject poisoned by arsenious acid, 
thereby agreeing with Professor Selmi who, in 
1873, met with the same ptomaine in two subjects 
also poisoned by arsenic. Hence it is seen that 
ptomaines will form as well in subjects who come 
to their death without poison, as in those who 
died from the ingestion of a poison, like arsenic, 
possessing strong antiseptic properties." 

Some of the ptomaines are very poisonous to 
man when ingested with food. An illustrative 
case of ptomaine poisoning is related as follows : 
" Twelve persons who had eaten a tainted goose 
containing an alkaloid resembling conia, offered 
all the symptoms of dangerous poisoning. One 
of them even died in a few hours, after copious 



PTOMAINES. 285 

vomitings, although no other cause of death but 
the presence of ptomaine could be detected. 
Hence it may be concluded that ptomaines can 
cause the death of man as well as of animals — as 
they are known to do. Much time is not neces- 
sary for the formation of these alkaloids, for the 
goose above mentioned had been bought at the 
market on the very morning of the poisoning ac- 
cident, and had passed the regulation inspec- 
tion." 

This should be a warning to those who have 
acquired a taste for what is called " high game," 
which is game in a more or less advanced state 
of decay and in which ptomaines have already 
been formed. 

The reported cases of poisoning ascribed to 
eating partridges that were supposed to have fed 
on the cocculus indicus or fish-berry, were, in all 
probality, ptomaine poisoning. 

Doctor Lauder Brunton, of London, cautions 
the people against the indiscriminate use of the 
digestive ferments and of artificially digested 
foods as likely to contain poisonous alkaloids. 
This caution may be extended to the case of 
canned foods. 

The existence of ptomaines has been denied, 
but the weight of evidence is overwhelmingly 
in favor of their formation in putrid animal mat- 



286 LEUCOMAINES. 

ter. Some of them are said to be very noxious, 
while others possess scarcely any toxic proper- 
ties. They are not developed until putrefaction 
is established, therefore refrigeration of the body 
has been recommended as the simplest means of 
retarding decomposition in case a medico-legal 
investigation should be necessary to establish the 
presence or absence of poison in the body. 

A case in point, is related, of a sudden death, 
where there were suspicions of poisoning. Doc- 
tor Brouardel, who had charge of the inquiry, 
caused the body to be immediately conveyed to 
the Paris Morgue for refrigeration. An examina- 
tion was duly made and no poison was found in 
the body. Had decomposition begun, a doubt 
would have arisen, and its solution would have 
been very difficult if not impossible if a ptomaine 
had been found and could not be easily dis- 
tinguished from a poisonous vegetable alkaloid. 

Leucomaines. — There have been many differences 
of opinion respecting the origin of leucomaines. 
According to Bouchard, alkaloids are found in 
animal matter where microscopic mushrooms 
live and swarm ; and he regards them as pro- 
ducts of the disintegration of vegetable or- 
ganisms. He thinks that, if these bacteria, living 
in animal matter, manufacture alkaloids, it may 
be asked if other bacteria, swarming in a living 



LEUCOMAINES. 287 

organism may not produce analogous substances. 
To verify this supposition he examined the urine 
of patients affected with infectious diseases and 
constantly found therein some of these alkaloids. 
However, distinct traces of such alkaloids are 
found in the urine of healthy persons, but this 
does not prove that they are not developed from 
forms of vegetable organisms. It was long ago 
shown that, in health, there are great quantities 
of microbia in the alimentary canal ; this being 
the case, alkaloids may be formed in the intes- 
tines, absorbed, and finally eliminated with the 
urine. 

Bouchard has shown that all recent fecal mat- 
ter contains alkaloids in amount proportionate to 
the quantity to microbia, and formulates the fol- 
lowing propositions : 

1. Alkaloids exist in the healthy human body ; 

2. They are manufactured in the digestive 
tube, and are apparently elaborated from vegeta- 
ble organisms, agents of intestinal putrefaction ; 

3. The alkaloids of normal urine represent a 
part of the alkaloids of the intestines, absorbed 
into the system and eliminated by the kidneys ; 

4. Diseases which tend to increase intestinal 
putrefactions, augment, by this process, the 
amount of the urinary alkaloids. 



288 LEUCOMAINES. 

5. While regarding as probable that these 
alkaloids, in certain infectious diseases, have for 
origin the microbia infesting the solids and fluids, 
it may be positively asserted that, in typhoid 
fever especially, a part, at least, of the urinary 
alkaloids are intestinal products. 

According to Gautier, leucomaines are only in 
part the products of bacterian ferments. He has 
shown that they do not all spring from this 
source for, he and others have found that the 
body contains the following named crystallizable 
alkaloids ; Karnine, Adenine, Guanine, Sarkine, 
Xanthocreatinine, Cr us creatinine, Amphicreatinine, 
Xanthine, and Pseudoxanthine , besides the " extrac- 
tives" which are very toxic. He accounts for 
their development as follows : he has demon- 
strated that the higher animals are anaerobic * 
in a considerable proportion, and it is now 
acknowledged that nearly two tenths of man's 
disassimilations are produced at the expense of 
the tissues themselves without any aid of oxy- 
gen ; the tissues living, in part, after the manner 



* The terms aerobia and anaerobia, were proposed by 
Pasteur to designate two classes of low organisms. The 
former incapable of living without free oxygen, and the latter 
multiplying itself indefinitely without the aid or presence of 
oxygen. 



LEUCOMAINES. 289 

of anaerobic or putrid ferments; the animal cells 
are then comparable, by their action on organic 
matter, to bacteria, and in their products of dis- 
assimilation should be found the same substances 
as in the products of putrid fermentation of the 
albumenoids. These alkaloids have been found 
not only in the urine, but in the blood, in the 
saliva, etc. 

In a physiological state, these poisons are 
eliminated by the kidneys, skin, and alimentary 
canal, when they have not been consumed by the 
oxygen of the blood, for they are ordinarily very 
oxydizable. 

When the aeration of the blood is imperfect, 
leucomaines or substances of their nature accu- 
mulate in the blood and give rise to morbid 
processes. Along with these substances there are 
others (the " extractives " ), equally nitrogenous 
but not alkaloidic, which always accompany them 
and are endowed with still greater toxic proper 
ties. If the elements of the tissues can act as do 
microbia and engender, like them, toxic products, 
it should be admitted that certain infections are 
not heterochtonous. The action of these poisons 
differs from that of animated beings by the fol- 
lowing characters : 

1. They act only when they are found in ap- 
preciable quantity in the organism. 



290 LEUCOMAINES. 

2. Their consequences have an intensity pro- 
portionate to quantity. 

3. These consequences are almost immediate, 
there being no incubation. 

Gautier thinks that an appreciable distinction 
may be made between bacterial and autochtonous 
alkaloids. But other observers entertain the be- 
lief that it is not possible in the present state of 
knowledge of the subject to indicate the precise 
point where the former series ends and the latter 
begins, for, some of them are common to both 
types. 

Doctor A. M. Brown has arranged the leu. 
comaines as follows : 

11 1. The Uric Leucomaine Group. — 
Betaines. 

Betaine is the representative of this group, hav- 
ing the chemical formula of 

(C H 3 ) 3 = N — O 
C 8 Hn N 2 = I 

C H 2 — C O. 

" The base was originally discovered in beet- 
root in 1866 by Scheifler, and in 1869 Liebreich 
detected its presence in human urine. 

1. Karnine, O Hs N 4 Os. — Commences the 
natural series of alkaloids of the urine groups. 
The base was isolated from imported meat by 



LEUCOMAINES. 29I 

Weidel, and afterwards in yeast waters by 
Schutzenberger. 

2. Adenine, C» H» N». — Discovered by Kossel 
in 1885. 

3. Guanine, C» H» N a O. — Discovered in 1884 
by Unger, and since met with in a great number 
of products of animal nature; in the flesh, the 
organs and the excremental matters of certain 
mammifera, in fowls, and fish, and also in certain 
plants. 

4. Sarkine or hypoxanthine, C» H« N4 O. — Found 
in certain plants, but for the most part in animal 
tissues. 

5. Xanthine, C» H* N4 (X — Is widely distrib- 
uted in the organism, in almost all the liquids and 
tissues of the animal economy from the splitting 
up of neucleine. The base was first isolated by 
Marcet in 18 19. 

6. Fseudo-xanthine, C< H 4 N* O. — Discovered 
by Gautier in the muscular tissue of the higher 
animals. 

" These last four leucomaines form a distinct 
group, as to community of origin, with analogous 
chemical properties : — (1,) They all possess a com- 
bination (C 5 H« N4) of a remarkable stability, 
analogous in certain respects to the stability of 
pyridic compounds. (2,) They can all give up 



292 LEUCOMAINES. 

cyanhydric acid, and two of them, xanthine and 
hypoxanthine, may be obtained synthetically in 
operating with the same cyanhydric acid. (3,) 
All of them are derived from albumenoid sub- 
stances by reactions which are identical in origin. 
(4,) Three of them present in a high degree that 
insolubility in water which the pyridic com- 
pounds exhibit. 

" Hydrocyanic acid forms the chemical skeleton 
of that cellular nucleus which is the most active 
phenomenon of vitality. 

" II. The Kreatinine Leucomaine Group. 

1. That well known base, Kreatinine, 

NH CO 

C< H 7 N 8 O N H = C I 

N (C H 3 ) — C H, 

heads the list of the other new alkaloids dis- 
covered by Gautier since 1881. They are all of 
fresh-meat origin. Kreatinine was discovered by 
Liebig in the action of chlorohydric acid on 
Kreatine, and Pettenkofer afterwards found it in 
human urine. 

2. Xantho-creatinine, C« H10 N4 O. — The most 
abundant of these bases, is of cadaveric odour, 
soluble in cold water, and with a strongly alkal- 
ine reaction. 

3. Crusocreatinine, C» He N« O. — Possessing the 



LEUCOMAINES. 293 

general properties of Kreatinine which it strongly 
resembles in chemical elements and alkalinity. 

4. Amphicreatinine \ C» Hi» N? (X — Corresponds 
with two molecules of Kreatine plus the C N H 
groupment, thus having the closest analogy to 
Kreatine, although the formula seems to differ 
widely from it. 

" III. An unclassified Group— According 
to their Sources. 

1. From the urine. — A uride — allantoine — and a 
base — Karnine — already known, a second alka- 
loid has been discovered with the formula O Hu 

2. From the blood and important viscera. — Alka- 
loids have been met with in appreciable quanti- 
ties. 

3. From the spleen. — Mr. Morel, of Lille, has ob- 
tained an alkaloid isolated in deliquescent crys- 
tals. 

4. From the intestines. — A base which seems to 
belong to the pyridic group isolated from 
choleraic dejections. 

5. From the saliva. — Gautier has determined 
the existence of an alkaloid in human saliva. 

6. From the venoms of certain snakes and batra- 
chians as well as certain mollusca and fishes. — 



294 LEUCOMAINES AND EXTRACTIVES. 

From this latter class, Brieger has identified an 
active principle in the mytiloxin and has given its 
formula as Ce Hi 6 N (X" 

The "Extractives." — It has been ascertained, 
that the ptomaines and leucomaines are accom- 
panied by equally nitrogenous but not alkaloidic 
substances the exact nature of which is not yet 
known. But the fact has been verified that they 
are endowed with greater toxic properties than 
the ptomaines and leucomaines. They are called 
the extractives for convenience of distinction. 
Not being well known, they cannot yet be prop- 
erly named. 

" According to the different sources of poison- 
ing ; there are different indications, signs, 

or symptoms, capable of classification as below : 
(i,) Poisoning by the ' extractives ' is attended by 
hyperthermia. (2,) Poisoning by the * animal 
alkaloids' is accompanied by hypothermia. (3,) 
A combination or succession of hyperthermic and 
hypothermic phenomena may become manifest, 
according to the combination or alternation of 
poisoning by the deleterious physiological pro- 
ducts, or their antagonistic action." (Brown, 
quoted from Aitken). 

The body of man in health may become pois- 
oned by the gradual accumulation, within itself, 
of deleterious substances normally elaborated but 



LEUCOMAINES AND EXTRACTIVES. 295 

imperfectly eliminated. Hence the slow and in- 
sidious onset of much ill health, from which re- 
covery is correspondingly slow. Constitutional 
diseases such as gout and rheumatism being 
examples of the effects of this auto-infection. 
(Aitken). How this auto-infection takes place 
Doctor Brown says, can only be understood and 
explained by the mode in which the phenomena 
of life are regarded. " Life is the result of the 
combination of many physiological processes, in 
the concurrent exercise of the bodily functions 
which are essentially relative and contingent on 
each other, implying at the same time a series of 
partial and local deaths. Thus it is that the 
organism lives on conditions of incessant elemen- 
tary disintegrations." 

Man resists the auto-infection to which he is 
constantly exposed; "(1,) by the elimination 
through the liver, the kidne}^s, the skin, the 
lungs, and the intestinal mucous membrane ; (2,) 
by the destruction of the toxic products by oxy- 
genation, which consists in a continuous combus. 
tion of the leucomaines by the oxygen of the 
blood, in which they are consumed, or partially 
in the tissues and organs." 

The foregoing summary of the present state of 
knowledge of the ptomaines, leucomaines and 
11 extractives," is abstracted from the works of 



296 GENESIS OF INFECTIOUS DISEASES. 

Hallopcau, * Cornil and Babes, f Gautier, % 
Brieger, || Brunton, ||| Brown, § Aitken, §§ and 
from the Chemical News. 1" 

The fact that the genesis of infectious diseases 
is bacteric or at least ptomainic, is accepted by 
many experienced pathoanatomists and practising 
physicians, and also by surgeons, particularly in 
the case of septicaemia occurring after severe in- 
juries or after surgical operations. 

The study of the clinical aspects of the 
ptomaines, leucomaincs, and " extractives," so 
well begun by Doctor Lauder Brunton and Sir 
William Aitken of London, by Professor Peter of 
Paris, and by other clinicians, will surely lead 



* Traite Elementaire de Pathologie Generate. Paris 1887. 

t Les Bacteries, etc. Paris 1886. 

\ Sur les alcaloides derives de la destruction bacterienne ou 
physiologique des tissues animaux. Bulletin de VAcadhnie 
de Medecine. Paris 1886. 

1 Microbes Ptomaines et Maladies. Ouvrage traduit de 
i'Allemand par le Dr. Roussy et J. Winter. Pari* 1887. 

HI On disorders of digestion, their consequences and treat- 
ment. London 1886. 

§ A Treatise on the Animal Alkaloids, Cadaveric and Vital ; 
or the Ptomaines and Leucomaines. London 1887. 

§§ On the Animal Alkaloids, etc. American edition. Phila- 
delphia 1887. 

f The " Chemical News," 1886-7. 



PYOSAPRAEMIA, BACTERIA. 297 

many physicians earnestly to consider this very 
important subject. 

For convenience and a clearer understanding 
of the subject it would be well for a number, if 
not all, of the bio-chemists, who are engaged in 
the investigation of the ptomaines, leucomaines 
and " extractives," to have a conference for the 
purpose of constructing a uniform nomenclature 
and classification of these toxic agents. 

34. Pyosapraemia* signifies putrid-pus infec- 
tion of the blood. The term pyaemia is ordina- 
rily employed to designate the condition above 
named, because it was originally believed that 
pus cells effected an entrance into the circulation. 
It is now known that the pus of a wound does 
not pass into the blood current, but that the ele- 
ments of putrid-pus make their way into the 
blood. Therefore the term pyosapraemia is the 
more exact. 

Pyosapraemia differs from septicaemia both 
clinically and pathically. Septicaemia often oc. 
curs before the formation of pus, and the blood is 
poisoned in the manner already stated, while 
pyosapraemia may not show itself until several 
weeks after the infliction of a wound. In sep- 
ticaemia there are generally no secondary ab- 



* From *uo?, pus, dovrpoS, putrid, and at'jia, blood. 



298 BACTERIA. 

scesses. In pyosapraemia infective thrombi, 
swarming with microorganisms, are formed in 
the veins and carried into circulation to cause 
multiple abscesses in the viscera and other parts 
of the body distant from the spot injured. In 
these thrombi, the staphylococcus and streptococcus 
pyogenes are found. 

A word concerning bacteria in general may not 
here be out of place, for their importance in 
medicine and surgery is undoubted by those who 
have critically examined the whole subject. The 
great question, not yet solved, is to what extent 
the bacteria themselves constitute the morbific 
cause, and to what extent this cause is to be 
sought in the infection of the blood by the alka- 
loids which these microorganisms manufacture. 

Bacteria. — Towards the end of the seventeenth 
century, Leuwenhoek discovered the leptothrix 
and vibrio in the saliva and faeces, and believed 
these microorganisms to be animalcules. It was 
not until 1838 that they were looked upon as 
bacteria. In his thesis for the doctorate in science 
(1853) Ch. Robin classed vibriones and bacteria 
with algae and yeast fungi. It is, however, only 
in the last fifteen or twenty years that bacteria 
have been largely studied in their relation to dis- 
ease. These studies were not instituted until 
some time after Davaine and Pasteur had demon- 



BACTERIA. 299 

strated the connection of bacteria with certain 
diseases of the lower animals, notably anthrax. 

The microbia are so largely diffused in the air, 
water and earth, and the destructive properties 
of these infinitely small organisms are so great 
that they have been styled the masters of the 
world. The schizomycetes, which contribute 
most of the pathogenic species, as their name im- 
plies, are multiplied by division and with great 
rapidity. They are parasitic, living upon organ- 
ized substances which they destroy by causing 
fermentation and putrefaction. They float in the 
air mixed with dust, are found in stagnant water, 
in sewers, in sluggish streams flowing through 
cities, in harbors, on the sea coast, and even in 
the depths of the ocean ; in fact wherever they 
find sustenance. They occur in large quantities 
in the mouth and in the fecal matter of man and 
beast. In the soil their quantity is prodigious, 
particularly in damp places, or during rainy 
season. Duclaux has shown that the germination 
of plants cannot take place in a soil which has 
been deprived of microorganisms, and that plants 
cannot utilise organic substances until these have 
been modified by the microbia. 

The bacteria infest the human body by effect- 
ing entrance principally through the respiratory 
and digestive organs. Cheese and fermented milk 



300 BACTERIA. 

are filled with microorganisms. It is said that 
the gastric juices arrest their growth. Pasteur 
and Duclaux are of opinion that digestion cannot 
be effected without their intervention. 

The schizomycetes probably appeared among 
the first vegetables. Van Tieghem has found 
them in coal. They have always occured in the 
mouth of man. Zopf and Miller have found rods 
of leptothrix upon the teeth of Egyptian mum- 
mies. (Cornil and Babes.) 

Since 1870 Cohn and other bacteriologists have 
devoted much time and labor to the study and 
arrangement of pathogenic microorganisms, and 
Budd, Pollender, Naegeli, Zopf, Van Tieghem, 
Koch, Rabenhorst, Fliigge, Sternberg, and many 
others have contributed valuable material in 
illustration of the assertion that "infectious dis- 
eases are due to a living contagion." * This 
statement, respecting infectious diseases, made, 
as a hypothesis, many years ago, by Henle, Sir 
Henry Holland, and J. K. Mitchell, of Philadel- 



* As long ago as the middle of the eighteenth century, 
Needham, Buffon, Spellanzani, Bonnet, and others, had 
demonstrated the existence of low organisms in putrid matter, 
but without clearly understanding their nature, although they 
considered these organisms as factors in the production of 
disease. 



BACTERIA. 30I 

phia, is now, by most pathoanatomists, considered 
as demonstrated. 

Davaine seems to have been the first to estab- 
lish that these microorganisms are vegetable and 
not, as originally believed, animal parasites. Cohn 
placed them in the class of Schizospores (cleav- 
ing spores) and found that they contained no 
chlorophyll. Naegli named them Schizomycetes 
(cleaving fungi), and Billroth asserted that they 
consisted of only one species, which he called 
coccobacteria septica. 

Cohn has divided morphically the schizomy- 
cetes into four groups : 

1. Sphero-bacteria, or globular bacteria, cocci \ 

2. Microbacteria, or bacteria in rods, short rods-, 

3. Desmobacteria, or bacilli, long rods ; 

4. Spiro-bacteria, or spiral bacteria, spirilla. 

SYNOPSIS 

OF cohn's classification of bacteria. 

Schizophytes. — Thallophytes being developed 
by division or by endogenous germinative cells. 

First tribe. — A. Free cells united by two or by 
four. 

Spherical cells chroococcus (Naegli). 

Cylindrical cells. . . .synechococcus (Naegli). 



302 BACTERIA. 

B. Cells united in zoogloeae by an amorphous 

substance. 

a. Cellular membrane confounded with the in- 

tercellular substance. 

Sphericial cells micrococcus (Hallier). 

Cylindrical cells. . .bacterium (Dujardin). 

b. Intercellular substance arranged in concen- 

tric layers. 

Round cells glaeocapsa. 

Cylindrical cells glaeothece. 

C. a. Cells forming circumscribed zoogloeae 

of definite form, families arranged in 

plates of a single layer. . . .rnerismopedia. 
Round cells arranged in a network of 

zoogloeae . clathrocystis. 

Cylindrical and cuneiform cells, families 

divided by constriction . . . coelosphaerium. 
Cells forming families with several layers 

united in cubical, colorless corpuscles, 

with quarternary arrangement .. .sarcina. 
Very great but undetermined number of 

colorless cells .... ascococcus. 

Second tribe, nematogenes. — Filamentous cells. 
A. Without ramifications : 
I. Cylindrical, colorless, with little marked 
division, very slender, short, bacillus ; — long, 
leptothrix. 



BACTERIA. 303 

2. Cylindrical filaments, thicker and longer r 
beggiatoa. 

3. Broken, with colorless conidia, crenothrix. 

4. Spiral, short, and undulated filaments, vi- 
briones ; — short, with rigid spirals, spirillum ; — 
long, with flexible spirals, containing phyco- 
chrome, spirocyth ; — long filaments and flexible 
spirals, spirulina. 

5. Filaments in beads without phycochrome, 
streptococcus. 

6. Cylindrical and colorless zoogloeae, myconos- 
toc; — in beads, nostoc; — filaments thinned at one 
extremity, rivolaria. 

B. Filaments with false ramifications, dado- 
thrix ; — cylindrical and colorless fila- 
ments, streptothrix. 

synopsis of 

zopf's pleomorphic classification of 

the schizomycetes * 

Zopf divides the schizomycetes (fission-fungi) 
into four groups : Coccaceae ; Bacteriaceae ; 
Leptotricheae ; Cladotricheae ; sixteen genera : 
Streptococcus ; Merismopedia ; Sarcina ; Micro- 



* Taken in greater part from Crookshank's Manual of 
Bacteriology. Second edition, 1887. 



304 BACTERIA. 

coccus ; Ascococcus ; — Bacterium ; Spirillum ; 
Leuconstoc ; Bacillus ; Vibrio ; Clostridium ; — 
Crenothrix ; Beggiatoa ; Phragmidiothrix ; Lep- 
tothrix, Cladothrix ; — and one hundred and 
ninety-five species. 

Group I. Coccaceae. 

Possessing, so far as known, only cocci, and 
thread forms resulting from the juxtaposition of 
cocci. The fission occurring in one or several 
directions. 

Genera: I, Streptococcus ; 2, Micrococcus; 3, 
Merismopedia ; 4, Sarcina ; 5, Ascococcus, 

Genus I. Streptococcus (chain cocci). 

Divide in only one direction. The cocci are 
generally united in the form of chains. 

Species. 

Species associated with disease in man and 
animals. 

1. Streptococcus pyogenes. .Pathogenic in man 

and animals. 

2. " {" malignus. .Saprophytic in 

man, patho- 
genic in ani- 
mals. 



BACTERIA. 305 

3. Streptococcus pygenes aureus. . . . Pathogenic 

in man and 
animals. 

4. " " albus Pathogenic in 

man and ani- 
mals. 

5- " " citreus Pathogenic in 

man and ani- 
mals. 

6. " cereus albus. .Associated with pus, 

but not pathogenic 
in man or animals. 

7. " cereus flavus. .Associated with pus, 

but not pathogenic 
in man or animals. 

8. " erysipelatosus.. Pathogenic in man 

and animals. 

9. " toxicatus Pathogenic (?) 

10. " in puerperal fever. .Possibly sapro- 

phytic only. 

11. " in endocarditis Possibly sapro- 

phytic only. 

12. " in diphtheria. ..... .Possibly sapro- 

phytic only. 

13. " articulorum .. Saprophytic in man, 

pathogenic in ani- 
mals. 



306 BACTERIA. 

14. Streptococcus in cerebro-spinal meningitis. . . 

Possibly saprophytic only. 

15. " in yellow-fever. .Possibly saprophy- 

tic only. 

16. " in dental caries .. Possibly saprophy- 

tic only. 

17. " variolae et vacciniae .. Pathogenic in 

man (?) and 
animals (?). 

Species associated with disease in animals. 

18. Streptococcus of swine-erysipelas ... Patho- 

genic (?). 

19. " of cattle plague Pathogenic. 

20. " of foot and mouth disease " 

21. " of septicaemia consecu- 

tive to anthrax " 

22. " septicus " 

23. " of progressive tissue ne- 

crosis in mice " 

24. " perniciosus Pathogenic (?). 

25. " bombycis Pathogenic. 

26. " insectorum Possibly saprophytic 

only. 

Species unassociated with disease. 

27. Streptococcus viscosus Zymogenic sapro- 

phyte. 



BACTERIA. 307 

28. Streptococcus coronatus . . Simple saprophyte. 

29. " radiatus " " 

30. " flavus desidens. . " " 

Genus II. Merismopedia, (Plate-cocci). 

Divide in two directions, forming lamellae or 
plates. 

Species. 
Species associated with disease. 

1. Merismopediagonorrhoeae.Pathogenic in man. 

2. Micrococcus tetragonus. .Saprophytic in man, 

pathogenic in ani- 
mals. 

3. Diplococcus albicans tardissimus.. Saprophytic 

in man. 
Species unassociated with disease. 
4 Micrococcus citreus conglomeratus. .Simple 

saprophyte. 

5. " subflavus Simple saprophyte. 

6. " albicans amplus. .. " " 

Genus III. Sarcina, (Packet-cocci). 
Divide in three directions, forming colonies in 
cubes or packets. 

Species. 

Unassociated with disease. 

1. Sarcina lutea Chromogenic saprophytes. 



308 



BACTERIA. 






Sarcina aurantiaca.Chromogenic saprophytes. 

ventriculi Simple saprophytes. 

intestinalis " " 

urinae " " 

litoralis 

Ritenbachii 

hyalina " " 

alba 



Genus IV. Micrococcus, (Mass-cocci). 

Divide in one direction, after division the cocci 
may remain aggregated in irregular heaps, but 
never form chains. 

Species. 

Species associated with disease in man. 

i. Micrococcus in scarlatina Possibly only 

saprophytic. 

2. u in measles. . ..Possibly only saprophytic. 

3. " in whooping 



5- 
6. 

7- 
8. 



cough 
" in haemophilia 
neonatorum 

" in typhus 

" in acute yellow 
atrophy 
" in dental caries 
" in gangrene . . . 



BACTERIA. 309 

9. Micrococcus pyogenes tenuis. .Possibly only 

saprophytic. 

10. " in rabies Pathogenic (?). 

In animals. 

11. "of septicaemia in rabbits Pathogenic. 

12. " of pyaemia " " " 

13. " of progressive suppuration in 

rabbits " 

14. " parvus ovatus " 

15. " of pyaemia in mice " 

In plants. 

16. Micrococcus amylivorus Pathogenic (?). 

Species unassociated with disease. 

17. Micrococcus cyaneus. . . .Chromogenic sapro- 

phyte. 

18. " aurantiacus.Chromogenic saprophyte. 

19. " chlorinus. .. " " 

20. " violaceus. .. " " 

21. " luteus " " 

22. " rosaceus ... " " 

23. " haematodes " " 

24. " candidus Simple saprophyte. 

25. " candicans " " 

26. " foetidus 

27. " crepusculum " " 

28. " cinnabareus " M 



3io 



BACTERIA. 



29. Micrococcus flavus lique- 

faciens Simple saprophyte. 

30. " " tardigradus 

31. " versicolor 

32. " viticulosus 

33. " lacteus faviformis. 

34. " fulvus 

Genus V. Ascococcus, (Pellicle-cocci). 

Are like the micrococci, but the cocci grow in 
characteristic gelatinous pellicles. 

Species. 

Unassociated with disease. 

I. Ascococcus Billrothii. Zymogenic saprophyte. 

Group II. Bacteriaceae. 

Possessing mostly cocci, rods (straight or bent), 
and thread forms (straight or spiral). The first 
may be absent, and the last possess no distinc- 
tion between base and apex. Division, as far as 
known, occurs in one direction. 

Genera: 1, Bacterium; 2 , Spirillum ; 3, Vibrio ; 
4, Leuconstoc, 5, Bacillus] 6, Clostridium. 

Genus I. Bacterium, 
Cocci and rods, or only rods, which are joined 



BACTERIA. 311 

to form threads. Spore-formation absent or un- 
known. 

Species. 

Species associated with disease in man and 
animals. 

1. Bacterium pneumoniae crouposae. ... Patho- 

genic (?); possibly 
only saprophytic 
in man, patho- 
genic in animals. 

2. " pseudo — pneumonicum.. Saprophytic in 

man, patho- 
genic in ani- 
mals. 

3. " Neapolitanum Saprophytic in man, 

pathogenic in ani- 
mals. 

4. " in rhinoscleroma. Pathogenic in man (?). 

5. " in diphtheria Saprophytic in man (?), 

pathogenic in ani- 
mals. 

6. " saprogenes Saprophytic in man, 

pathogenic in ani- 
mals. 

7. " decalvans Saprophytic. 



312 BACTERIA. 

Species associated with disease in animals. 

8. Bacterium in diphtheria of calves Patho- 

genic (?). 

9. " in diphtheria of pigeons Pathogenic. 

10. " cholerae gallinarum 

11. " septicum agrigenum 

12. " of septicaemia in rabbits. . . . 

13. " of Davaine's septicaemia. .. . 

14. " septicum sputigenum 

15. " crassum sputigenum 

16. " pneumonicum agile 

17. " oxytocum perniciosum 

18. " cavicida 

19. " coli commune 

20. " lactis aerogenes 

21. Panhistophyton ovatum 

In plants. 

22. Bacterium hyacinthi Pathogenic (?). 

Species unassociated with disease. 

23. Bacterium synxanthum. .Chromogenic sapro- 

phyte. 

24. " indicum Chromogenic saprophyte. 

25. " rubrum " " 

26. " prodigiosum . . w M 

27. " luteum " " 

28. " violaceum ... " " 



BACTERIA. 313 

29. Bacterium brun- 

neum..Chromogenic saprophyte. 

30. " fluorescens 

putidum " " 

31. " fluorescens 

liquefaciens " " 

32. " ureae Zymogenic saprophyte. 

33. " aceti 

34. " Pasteurianum. . M " 

35. " liodermos Simple M 

36. " multipediculum .... u " 

37. " ramosum lique- 

faciens. " " 

38. " Zopfii 

39. M merismopedioides " " 

40. *' Fflugeri 

41. " photometricum " M 

42. u litoreum " 

43. " fusiforme " 

44. 4< navicula " 

45. Proteus vulgaris 

46. " mirabilis " 

47. li Zenkeri " 

48. Bacterium termo " 

49. " lineola " " 

Genus If. Spirillum. 
Threads screw-form, made up of short or long 



11 

u 

11 n 

(< ti 

ti 
14 



314 BACTERIA. 

rods only, or of rods and cocci. Spore-formation 
absent or unknown. 

Species. 

Species associated with disease in man and 
animals. 

1. Spirillum Obermeieri Pathogenic. 

2. " cholerae Asiaticae.Pathogenic in man(?), 

possibly only sapro- 
phytic. Pathogenic 
in animals. 

3. " Finkleri. . . . Saprophytic in man. Patho- 

genic in animals. 

4. " tyrogenum . Saprophytic. Pathogenic in 

animals. 

5. " sputigenum.Saprophytic. Pathogenic in 

animals. 

Species unassociated with disease. 

6. Spirillum plicatile Simple saprophyte. 

7. " serpens 

8. " tenue 

9. " undula 

10. " volutans 

ir. " Rosenbergii 

12. " attenuatum ..... 

13. " leucomelaneum . . . 



BACTERIA. 315 

Genus III. Leuconstoc. 

Cocci and rods. Spore-formation present in 
cocci. 

Species. 
Unassociated with disease. 
1. Leuconstoc mesenteroides Zymogenic sa- 
prophyte. 

Genus IV. Bacillus, 

Cocci and rods, or rods only, forming straight 
or twisted threads. Spore-formation present 
either in rods or cocci. 

Species. 

Species associated with disease in man and 

animals. 

1. Bacillus leprae Pathogenic. 

2. " in syphilis Pathogenic (?) ; possibly 

only saprophytic. 

3. " typhosus Pathogenic (?) ; possibly 

only saprophytic. 

4. " malariae. ..Pathogenic in man (?), patho- 

genic in animals. 

5. " of choleraic diarrhoea from 

meat poisoning. .Pathogenic. 

6. " pyogenes foetidus.. Saprophytic in man, 

pathogenic in animals. 



3l6 BACTERIA. 

7. Bacillus in septicaemia in man. .Saprophytic. 

8. " in gangrenous septicaemia. " 

9. " tuberculosis Pathogenic. 

10. " antracis " 

11. " mallei " 

12. " of malignant oedema (ani- 

mals) 

13. " of septicaemia of mice " 

14. " of ulcerative stomatitis in 

the calf tm 

15. "swine-typhoid " 

16. " swine-erysipelas " 

17. " in tetanus (animals) Pathogenic (?). 

18. " alvei (animals) Pathogenic. 

Species unassociated with disease. 

19. Bacillus ianthinus. .Chromogenic saprophyte. 

20. " pyocyaneus.. " rt 

21. " cyanogenus.. " u 

22. " acidi lactici Zymogenic " 

23. " Fitzianus " " 

24. " subtilis Simple " 

25. " figurans " " 

26. " of jequirity " 

27. " caucasicus " 

28. " dysodes " 

29. " Hansenii " 

30. " erythrosporus " 



BACTERIA. 317 

31. Bacillus septicus Simple saprophyte. 

32. " saprogenes 

33. " foetidus 

34. " putrificus coli 

35. " coprogenus foetidus. 

36. " aerophilus 

37. " mesentericus fuscus. 

38. " " vulgatus 

Genus V. Vibrio. 
Threads screw-form in long or short links. 
Spore-formation present. 

Species. 

Unassociated with disease. 

I. Vibrio rugula Zymogenic saprophyte. 

Genus VI. Clostridium. 
Same as bacillus, but the spore-formation is in 
characteristically enlarged rods. 

Species. 
Associated with disease in animals. 

1. Clostridium of symptomatic anthrax. . .Patho- 

genic. 

Unassociated with disease. 

2. Clostridium butyricum. Zymogenic saprophyte. 

3. " polymyxa. " " 



318 BACTERIA. 

Group III. Leptotricheae. 

Possessing cocci, rods, and thread forms (which 
show a distinction between base and apex). The 
last straight or spiral. 

Genera: I, Crenothrix ; 2, Bcggiatoa ; 3, Phrag- 
midiothrix ; 4, Lepothrix. 

Genus I. Crenothrix, 

Threads articulated ; cells sulphurless ; habitat 
water. 

Species. 

Unassociated with disease. 

I. Crenothrix Kiihniana Simple saprophyte. 

Genus II. Beggiatoa. 
Threads unarticulated ; cells with sulphur 
granules; habitat water. 

Species. 
Unassociated with disease. 

1. Beggiatoa alba Simple saprophyte. 

2. " mirabilis " " 

3. " roseopersicina. .Chromogenic " 

Genus III. Phragmidiothrix. 

Threads jointless ; successive subdivision of the 
cells is continuous; cells sulphurless; habitat 
water. 



BACTERIA. 319 

Species, 

Unassociated with disease. 
1, Phragmidiothrix multiseptata. . .Simple sapro- 
phyte. 

Genus IV. Leptothrix. 
Threads articulated or unarticulated ; succes- 
sive subdivisions of cells not continuous; cells 
sulphurless. 

Species. 
Associated with disease. 

1. Leptothrix buccalis Saprophytic. 

2. " gigantea " 

Group IV. Cladotricheae. 

Possessing cocci, rods, threads, and spirals. 
Thread-forms provided with false branchings. 
Genus, Cladothrix. 

Genus I. Cladothrix. 

Species. 

Unassociated with disease. 

1. Cladothrix dichotoma Saprophyte. 

2. " Foersteri " 

Associated with disease. 

3. Actinomyces Pathogenic. 



320 



BACTERIA. 



This classfication although very defective is the 
most easily followed and seems to give a clearer 
view of existing knowlege of schizomycetes than 
any of the others. 

Fliigge divides the bacteria into four classes: 
i. Fungi 

2. Mycetozoa 

3. Blastomycetes 

4. Schizomycetes. 

Most of the pathogenic organisms belonging to 
the fourth class, he reckons the following as 
members of this class : 



I. 


Micrococcus 


8. 


Beggiatoa 


2. 


Ascococcus 


9- 


Spirillum 


3- 


Sarcina 


10. 


Spirochaete 


4- 


Clathrocystis 


11. 


Streptothrix 


5- 


Bacterium 


12. 


Cladothrix 


6. 


Bacillus 


13. 


Myconstoc. 


7- 


Leptothrix 







Of doubtful relation to the schizomycetes are 
the crusothrix, sphaerotilus, spiromonas, rhab- 
domonas, Monas Okeini, and Warmingii vinosa. 
(Communicated by Doctor Biggs). 

The arrangement of Fliigge, being the same as 
that of Rabenhorst, is one of the most recent and 
is considered as the best by many histologists. 

The " classifications of bacteria " are as vary 



BACTERIA. 321 

ing and unsatisfactory as they are numerous. A 
short time ago the suggestion was made, to a dis- 
tinguished bacteriologist, that it would be very 
desirable to establish a uniform nomenclature 
and classification of microbia. He replied that 
the time had not yet come for this, because 
knowledge on the subject of bacteria is insuf- 
ficient to permit of such classification. 

A similar reply has often been made in connec- 
tion with the classification of diseases. The 
proper time, however, to begin to classify is al- 
ways the present, for, it should be remembered 
that to think is to classify. But to classify well 
requires of the thinker that he shall think well ; 
and well directed thoughts are likely to lead to 
great advances. 

If the bacteriologists should decide to work in 
unison and in harmony with the single purpose 
of advancing science, setting aside all personality, 
the first and wisest step to take would be, after 
having agreed upon a proper basis and method 
of nomenclature and classification, to describe 
fully and accurately the known bacteria, then 
carefully analyze the descriptions, and deduce 
therefrom the definitions which will almost in- 
variably furnish correct names. Thus they would 
establish a uniform and true classification which 
would be understood by the whole profession. 



322 BACTERIA. 

The outcome of the needed investigations 
would be the proper construction of the genera, 
the gathering together of the species, the relega- 
tion to the lower rank of varieties, of many that 
now stand as species, and the discovery of new 
species. Much greater advances would thus be 
made than by waiting indefinitely for " the 
proper time to come." Then the clinicians would 
be able to use to advantage the knowledge at- 
tained of the nature and pathic properties of 
these deadly enemies of suffering humanity. 

The study entailed by the preparation of the 
summary of the present state of knowledge of 
the bacteria, ptomaines, leucomaines and "ex- 
tractives," has led to the following conclusions: 

i. That pathohistology needs to be recon- 
structed on the basis of bio-chemistry. 

2. That hygiene should be given a position of 
much greater importance that it has ever oc- 
cupied. 

3. That prophylaxy should be placed on a 
firmer footing than heretofore. 

4. That the State should come in aid with 
money and laws, to further the views of the 
medical profession in the means proposed for 
preventing disease and hindering epidemics. 

5. That therapy should be subjected to many 



DISTURBANCES IN THE CIRCULATION. 323 

modifications, in correspondence with the great 
advances in pathohistology. 

6. That the junior student (the Doctor of the 
future) should devote more time to laboratory 
work, and to experimental medicine, and should 
be more thoroughly trained to methods of pre- 
cision than in the past. 

II. Disturbances in the Circulatory 
Apparatus. 

I. Ischaemia, from t'dx^iy, to check, to restrain, 
and ai'/uoc, blood, signifies arrest of blood, and is 
employed only in the sense of a local disturbance 
in the circulation. It arises from constriction of 
the capillaries owing to disturbance in the vaso- 
motor nerves. The plugging of an arteriole is 
also a factor in the production of ischaemia. It 
is too, the effect of frost-bite of the tips of the 
toes, fingers, ears or nose. The result of ischaemia 
is local capillary anaemia which may be followed 
by colliquative necrosis in certain tissues, and in 
others by moist or by dry gangrene. 

If there should not be sufficient constriction of 
the capillaries to arrest the circulation in a given 
part, but enough to interfere with nutrition, the 
condition would be one of local capillary hypo- 
aemia. 



324 DISTURBANCES IN THE CIRCULATION. 

The term ischaemia has been improperly used 
to designate " local arterial anaemia," and also 
the "retention or suppression of an habitual flux 
of blood as of the haemorrhoidal, menstrual, flux, 
or of epistaxis." 

2. Athroisaemia, — from aQpoidjua, accumulation, 
and ai'/ja, blood, — signifies blood accumulation, 
congestion. It is a more exact term than conges- 
tion which is applied alike to the accumulation of 
any other fluid. The French employ the term 
engorgement to designate the state of a part 
gorged with blood or some other fluid. The 
words synathroismus, haemostasia and many 
others have been suggested to take the place of 
congestion. But some of them are used in dif- 
ferent senses, as for instance haemostasia which^ 
besides signifying stagnation of blood, is made to 
do duty in designating a means to arrest haemor- 
rhage ; haemostatic being derived therefrom. 

" Congestion, — from conger o, I heap up, — is de- 
fined as the accumulation of blood in the blood 
vessels of an organ." 

" Active congestion expresses the condition of 
overfulness of blood vessels arising from paralysis 
of the vaso motor and increased energy of the 
vaso-dilator nerves, such as occurs in the surface 
redness of active exercise, or in the early stage of 
inflammation." " Passive congestion — from pass- 



DISTURBANCES IN THE CIRCULATION. 325 

tvus, suffering-, — is an overplus of blood in the 
capillary vessels of a part, associated with impair- 
ment of the vital relations between the blood and 
the minute elements of the texture, as the cause 
of the sluggish flow of blood in the capillaries.'* 
(Ailken.) 

These descriptions are good and clear, but 
there is no syllable in the word congestion to in- 
dicate that it is the blood which is heaped up. 

3. Phlegmasia; inflammation. (See p. 52.) 

4. Lymphexosmosis signifies a transudation 
from lymph-vessels. 

5. Lymphorrhagia signifies a flow from a rent 
lymph-vessel. Rhagia has been wrongly applied 
exclusively to flow of blood. It simply means a 
breaking forth, and may therefore be used as a 
terminal to lympho as well as to haemo. 

6. Haemorrhagia signifies a flow from a rent or 
cut blood vessel. 

7. Haemodiapedisis signifies an oozing of blood 
through the walls of vessels. This is commonly 
but wrongly confounded with haemorrhage 
which always implies a solution of continuity. 

8. Thrombosis, — from Qpojttfios, a clot, and «>oi$, 
— signifies coagulation. The coagulation may 
take place in a blood vessel, or in the heart ; 



326 ALTERATIONS OF STRUCTURE. 

hence angiohaemothrombus, cardiohaemothrom- 
bus. 

9. Embolism us, from s/ifioXos, a plug — signifies 
simply plugging. An angioembolus is a vessel- 
plug. 

III. Pathengenetic Alterations of 
Structure. 

The terms pathogenetic and pathengenetic 
should not be confounded. Pathogenetic is an 
adjective signifying that which generates, disease 
generating, while pathengenetic, — from eyyevi^, 
sprung from, — signifies that which is generated, 
engendered by disease. In other words a pathen- 
genetic affection is a disease which has sprung 
from, or has been engendered by a preexisting 
disease. This word was suggested by Doctor 
Alfred L. Carroll. (See p. 56.) 

1. Hypertrophy, — from vxep, over, above, — 
signifies over nourishment, and is here used in its 
true meaning of increased nutrition and not in- 
creased bulk. (See pp. 53-55.) 

2. Hypotrophy, — i'tto, uider, — signifies de- 
creased nutrition, and is here employed in its 
strict sense of diminished nutrition. (See pp. 
53-550 

3. Auxesis is used in the sense of enlargement, 



RETROGRADE METAMORPHOSES. 327 

increase, and is substituted for hypertrophy. 
(See pp, 52-55.) 

4. Ectasis signifies dilatation, expansion. (See 
P- 570 

5. Stenosis signifies contraction, stricture. (See 

p. 56.) 

6. Ecmasis signifies obstacle, obstruction. (See 
P- 57-) 

IV. Retrograde Metamorphoses. 

1. Necrosis, — from vexpoa), I kill, — signifies 
death. As it is here used, death of a part. The 
following are the principal necrotic processes 
named by the pathoanatomists: Coagulation, 
colliquative and cheesy necrosis, ulceration, and 
humid and dry gangrene. 

2. Meiosis, — from jueicojua, decrease, — signifies 
a decrease in the size of a part which may or may 
not shrivel. Meiosis is here employed to signify 
a decrease in the size of an organ, whatever may 
be the cause of the retrogression. It is offered as 
a substitute for atrophy which should be used 
solely to signify cessation of nutrition, in which 
sense it is a precursor of mortification. (See p. 
54-) 

3. Degeneration of tissues is their substitution 



328 NEOPLASMS. 

by subordinate elements, such as granules and 
fat, and amyloid, colloid, mucoid, hyaline, inoid, 
and sclerous substances. 

4. Infiltration of tissues is the permeation of 
any texture by a fluid, or by a solid substance in 
suspension or in solution. Examples : fatty, pig- 
mentary, calcareous, uric, infiltration. 

V. Neoplasms. 

The name neoplasm was given by Burdach to 
the new formations whose fundamental tissue he 
regarded as consisting of morbid cellular sub- 
stance. Virchow adopted the term, and nearly 
all pathoanatomists have since done so, in the 
sense of the morbid growths arising from simple 
division or from endogenous multiplication of 
preexisting cells. 

It has been questioned if, strictly, there can be, 
in the human body, such a development as a new- 
growth. In reality the growth is new to the 
particular part whence it springs, though it may 
be composed of the same tissues that exist nor- 
mally in this part. In this sense it may be said 
that the new-growth must be composed of tissues 
lying within the possibilities of the individual. 
In the other sense it must be entirely foreign. 
The examples given are : (1,) a growth composed 



NEOPLASMS. 329 

of feathers would be a new-growth in man ; (2,) a 
growth composed of hairs would be a new- 
growth in a bird. But some histologists would 
say there are, in this sense, strictly new-growths 
in man, e. g., actinomycosis, rhinoscleroma, etc., 
which are not even composed of animal sub- 
stances, but of vegetable microorganisms. 

The term neoplasm cannot yet be rejected 
when used in the sense of a growth representing 
the excessive development of tissues which are 
identical with or, at least, resemble those of the 
normal constituents of the body. " Though the 
cells of human neoplasms may deviate in their 
appearance from the cells of normal tissues, this 
deviation is not so extreme that their analogues 
cannot be met with in some parts of the normal 
body during intra or extra uterine life." 

It may be of interest to trace, from the early 
writers, the history of the development of the 
present knowledge of neoplasms, which were 
called tumors and are still so named by many 
pathoanatomists. Paul Broca, in his, " Traite des 
Tumcurs" (1866), has given a more full and com- 
plete account of this development than most 
other authors. The following is therefore, in 
part, abstracted from his classical work. 

The word tumor, which Broca uses under pro- 
test, signifies, he says, in its most general accepta- 



330 NEOPLASMS. 

tion, any increase of volume, abnormal prom- 
inence, or new production, apparent or con- 
cealed, internal or external. 

The ancients, and their followers until the re- 
naissance, and even many during the seventeenth 
and eighteenth centuries, have divided the tu- 
mors into three great groups: tumores secundum 
naturam, supra naturam, praeter naturatn. These 
terms were accepted by all but with no consense 
as to the exact signification which they should 
bear. In the first group were placed the im- 
pregnated uterus, and the consequent enlarge- 
ment of the mammae. In the second group were 
included those tumors arising from the displace- 
ment of natural parts, such as fractures, and dis- 
locations of bones, etc. In the third group were 
the tumors that arise, not from the natural parts, 
but from the development of new tissues or the 
accumulation of the humors. This last group 
formed one of the grand divisions of surgery.* 



* The surgical Pentateuch was divided into five books : 
{i,) Wounds; (2,) Ulcers; (3 ) Fractures ; (4.) Luxations ; 
(5,) Praeternatural tumors. The fifth book constituting more 
than three-founhs of surgery. In it were placed, dry gan- 
grene, skin diseases, and all other maladies that could not 
enter into the first four bx>ks. Galen wrote of Tumores 
j>raeter naturam, and, says Broca, this Galenic doctrine is 
reproduced in several of his other works. Tagault's, In- 



NEOPLASMS. 331 

Thus in this fourth group the most dissimilar 
diseases were placed side by side, simply because, 
according to the Galenic doctrine, they were 
supposed to spring from the same causes. All 
the praeternatural tumors were said to arise from 
the accumulation of one of the humors of the 
economy, hence they were also called humoral 
tumors. They resulted either from fluxion or 
from congestion. — Fluxion occurred when a nat- 
ural humor was attracted to, and remained in, the 
affected part, and congestion when the humor 
was engendered in loco. The humors enumerated 
by the Galenists were four: (1,) the blood ; (2,) 
the bile ; (3,) the phlegm ; (4,) the atrabile or 
melancholy. Giving rise to phlegmons, erysipe- 
las, oedema, scirrhus. Later a fifth was added, 
the windy humor, which produced emphysema 
or pneumatosis (inflation). Then there were 
mixed tumors, those caused by two or several 
humors. 

stitutiones Chirurgicae, Paris 1543, contains a book, De 
tumoribus praeter naturam. This author appears to be the 
first to give an analytical classification of tumors which he 
groups in accordance wilh the five species of humors ; the 
fifth species being the windy humor, producing inflationes. 
Broca traces down to Didier, of Montpellier, 171 1, the ancient 
arrangement of tumors into the three groups, the last of which 
being tumores praeier naturam. 



332 NEOPLASMS. 

Humorism was succeeded by solidism, and this 
latter doctrine, in its turn, was overwhelmed by 
the advances of anatomy, and the tumor cs praeter 
naturam ceased to exist after phlegmons, erysipe- 
las, oedema, and emphysema were removed from 
the group. The term tumor whose nosographical 
acceptation became more restricted, was finally 
reserved to designate accidental productions, in 
the organism, characterized by the formation of 
new tissue. 

The Galenists supposed scirrhous tumors to 
spring from the accumulation of atrabile. The 
innovators of the seventeenth century failed to 
find this mythical humor, but discovered lymph 
which served to establish a new theory of tumors. 
It is plain that the solidists were humorists with- 
out being aware of the fact, for they thought 
most tumors due to the extravasation of lymph ; 
that their various forms, and their various term- 
inations, resulted from the different degrees of 
crudity, coction, acidity, alcalinity, density r 
acrimony, depravation, or fermentation of this 
capricious humor ; and that these phenomena 
varied as the lymph was naturally more or less 
thick, or stagnant, and that the affected part pos- 
sessed greater or less heat. 

While the theory of the day ascribed to most 
tumors a common cause, the practical physicians 



NEOPLASMS. 333 

discovered great diversity instead of the pre- 
tended unity of cause. Under the sway of the 
atrabile theory also this contradiction had become 
apparent, and, to escape from the dilemma, the 
foundation was laid of a doctrine more likely, as 
it was thought, to be adopted. The atrabile 
theory was so vague that it possessed an almost 
indefinite elasticity in the minds of its promotors 
and yielded to all their fancies. Lymph, on the 
contrary, had a real existence, had been seen and 
analyzed, and though the characters attributed 
to it were far from being exact, they were form- 
ulated with precision. One of these characters 
was its coagulability by heat, and the appearance 
of a scum at the surface of the water in which 
tissues impregnated with lymph were boiled. 
The anatomical study of tumors consisted in boil- 
ing them, and, as nearly all furnished a scum, it 
was concluded that they were of lymphatic 
origin. This experiment was believed to estab- 
lish the unity of cause of nearly all tumors. 
This unity of cause granted, it was necessary 
to explain why it was that some of these tumors 
were benign and others malignant. The promo- 
tors of the theory then had recourse to the hypo- 
thesis of degeneration, that is to say, the trans- 
formation of benign into malignant tumors by 
reason of the depravation of the lymph. The 



334 NEOPLASMS. 

Galenists had already offered a similar explana- 
tion, for they regarded cancer as inflamed or 
degenerated scirrhus. But the adherents of the 
lymph doctrine applied the degeneration hypo- 
thesis to all, even to scrophulous and lipomatous, 
tumors, to cysts and to wens. The degeneration 
hypothesis seems to have been a compromise be- 
tween the lymph theory, and clinical observation 
which proved the diversity as against the unicity 
of cause of tumors. This hypothesis was ad- 
mitted by all without inquiry as to its actual or 
possible demonstration. The Galenists had in- 
vented it to save the atrabile doctrine, and the 
solidists to save the lymph doctrine. This de- 
generation hypothesis has survived the wreck of 
the two doctrines, and exists in the minds of 
many unto this day, as do other false doctrines. 

Such were the vagaries of the seventeenth and 
eighteenth centuries respecting the nature of tu- 
mors. The first step in advance was made by 
Littre who, in 1704, discovered a certain tumor 
to be composed of adipose tissue. Afterwards, 
in 1709, he proposed that tumors of this genus be 
named lipomata. Here then was a distinct 
demonstration of an abnormal development of a 
normal tissue. But as this was contrary to the 
existing doctrine, no attention was paid to the 
statement Soon after, new observations showed 



NEOPLASMS. 33£ 

that other tumors were formed, by the morbid 
increase of preexisting elements, without the in- 
tervention of extravasated lymph. It was partic- 
ularly the study of encysted tumors and wens 
which led to this conclusion. Astruc and others 
thought that these tumors resulted from the dila- 
tation of lymphatic vessels. Louis rejected this 
hypothesis, and said that cysts were formed in 
the cellular tissue, their walls being composed of 
condensed cellular and not of a new tissue. In 
1775, Girard attributed the formation of sebac- 
eous cysts to the obliteration of the ducts of 
sebaceous glands. So that gradually, cysts and 
wens were removed from the category of de- 
generating tumors, since they were supposed not 
to be of lymphatic origin. Finally scrophulous 
tumors were also removed from this category. 
Then all the other tumors were united in a single 
group under the name of fleshy tumors, by the 
advocates of the lymph theory. The extravasated 
and hardened lymph caused scirrhus, and when 
this lymph fermented the scirrhus was changed 
into cancer. Certain tumors were supposed to 
remain scirrhous and therefore benign, some 
were transformed into cancer and were therefore 
malignant, while others were cancerous and 
therefore malignant from the beginning. All this 
depended upon the freaks of the lymph. There 



33^ NEOPLASMS. 

was no pathoanatomy in those days, so this con- 
fusion respecting tumors is not to be wondered 
at. Still some advance was made, though of a 
negative character, for it consisted in the elimina- 
tion, from the group, of morbid states which 
were not properly tumors. 

The question what is cancer, was put by the 
Academy of Lyons, and a prize offered for some 
approach to its solution. Peyrilhe to whom, in 
1 773t the prize was awarded, announced as his 
conclusion that it was as difficult to define as to 
cure cancer. 

John Hunter gave the last stroke to the de- 
generation theory, and though his was also a 
lymph theory, it was of another kind of lymph. 
The lymph of the solidists was a dead substance 
cast away by the lymph vessels, a foreign body 
which underwent fermentation, etc., but that of 
Hunter was a transudation, from the blood- 
vessels, endowed with the property of coagulat- 
ing and of becoming organized. Here then is an 
implied suggestion that tumors might be re- 
garded as organs superadded to the economy, for 
he considered that their tissues were nourished, 
as the tissues of the normal parts of the body, 
and increased in size by virtue of this nutrition. 
In his " Lectures on the Principles of Surgery," he 
defines a tumor as " a circumscribed enlargement 



NEOPLASMS. 337 

in a part from disease ; not strictly a disease of a 
natural circumscribed part, as a thickened dis- 
eased gland." Tumors, he says, " seem to de- 
pend on an accumulation of extravasated co- 
agulable lymph, either in the adipose or cellular 

membrane or both The increase of cancer 

is much in the same way." He divides tumors 
into solid and encysted. Solid tumors are sub- 
divided into "three species: (i,) Warts; (2,) 
Polypi; and (3,) An entirely new substance in the 
cellular membrane, often irregular, and attached 
by loose cellular membrane to the surrrounding 
parts." Among the encysted tumors he places 
hydatids and most of the known cysts. He 
classes tubercles under the head of "spurious 
tumors." 

The advent of Bichat, and of his creation of 
general anatomy, from which pathoanatomy is- 
sued, changed, much for the better, the aspect of 
the question of tumors and gave a basis for their 
classification. His premature death did not re- 
tard the progress of general and pathoanatomy, 
because he had inspired his disciples with his 
own great zeal in the pursuance of these newly 
created departments of anatomy. Laenec was 
the foremost of his followers in the application of 
anatomy to the study of disease. It was in 
December 1804 that he produced the "note sur 



338 NEOPLASMS. 

Vanatontie pathologique" This was the starting- 
point of general pathology. 

Laenec divided accidental tissues into two 
great categories: (i,) Those having analogues 
among the normal tissues ; (2,) Those having no 
analogues among normal tissues. Since then, for 
brevity, they have been designated as homolog- 
ous and heterologous tumors. 

He reckoned as many homologous tumors as 
there »are normal tissues : i. e. osseous, fibrous, 
libro-cartilaginous, cartilaginous, cellular or adi- 
pose, horny, etc.* and added hairs produced in 
certain cysts, the adventitious serous membranes 
discovered by Bichat, and giving rise to certain 
encysted tumors, etc. 

Of heterologous tumors he numbered four : 
(1,) Tuberculous; (2,) Scirrhous; (3,) Encephal- 
oid ; and (4,) Melanotic. 

He used the term encephaloid to designate 
those soft cancerous tumors which, on gross in- 
spection, bear a resemblance to cerebral sub- 
stance. It will be remembered that, even then, 
soft cancers were, by many, regarded as degen- 
erated scirrhous tumors, still believed to be be- 
nign. He v declared that the two types — encephal- 
oid and scirrhus — remained distinct from first to 
last, and J that they were composed of tissues 
which were never interchangeable. While on 



NEOPLASMS. 339 

the one hand this statement was an advance, dis- 
posing as it did of the question of fermentative 
degeneration, on the other hand it still left a 
doubt as to the real character of scirrhus. En- 
cephaloid and scirrhus being regarded as two 
different diseases, and the former being cancerous, 
the nature of the latter should have been, but 
was not, stated. What added to the existing con- 
fusion was that the two diseases had been found 
in the same individual, and that, aside from the 
difference in physical appearance, the symptoms 
of the two were analogous, they showed the 
same tendency to recurrence, and their termina- 
tion was the same. Clinical observation and 
pathoanatomy were apparently at varience. The 
microscope had not yet come in aid to settle the 
vexed question. It will not seem strange then 
that the doctrine of Broussais, ascribing to in- 
flammatory action the formation of all tumors, 
should have been so readily embraced. At 
length however it was abandoned and even the 
most devoted of Broussais' pupils returned to 
Laenec's classification. 

While the French were endeavoring to solve 
certain questions connected with tumors, the 
English were laboring in the same direction. 
John Hunter had given the right impulse to the 
cancer question, and his successors were striving 



340 NEOPLASMS. 

to determine which of the many tumors should 
be classed as malignant, and which benign. 
Among these men were Sir Everard Home, Wil- 
liam Hey, Samuel Sharpe and John Abernethy. 

In the beginning of this century there was 
founded in London a " Society for investigating 
the nature and cure of cancer." That society 
then appointed a committee, consisting of Doc- 
tors Baillie, Sims, and Willan, Messrs. Sharpe, 
Home, Pearson and Abernethy, with Doctor 
Denman as Secretary, charged to prepare a pro- 
gramme consisting of thirteen queries relating to 
the nature, diagnosis and management of cancer. 
These queries to be answered by the profession 
at large. The programme was issued in the year 
1802, and was reprinted in the Edinburgh Med- 
ical Journal, July 1806. The effort was fruitless, 
and the society soon ceased to exist, but individ- 
uals continued the work; among them, Hey, 
Burns, Home, Wardrop, Abernethy and Law- 
rence. 

" Fungus haematodes " regarded as non-malig- 
nant by Hey, Burns and Wardrop and as malig- 
nant by Young, was confounded with erectile 
tumors by Maunoir, and was not, for a long time, 
classed as a variety of encephaloid carcinoma. 
Hey and Burns were the first to call attention to 
these pulsating tumors containing extravasated 



NEOPLASMS. 341 

blood; then Wardrop, Else, Bradley, Young, 
Travers and Sir Astley Cooper, contributed each 
his share to their study. 

John Abernethy * appears to have been the 
first to propose an anatomical classification of 
tumors, Lacnec's contribution having been made 
several months later (December 1804). Abernethy 
believed that a proper understanding of the sub- 
ject could be attained only by associated labor, — 
but this was, for the time, rendered impossible by 
the dissolution of the Cancer Society, — and un- 
dertook his task with the modest statement that, 
though imperfect, his arrangement would, he 
hoped, awaken the attention of many others to 
the question. 

He denned a tumor as a swelling due to some 
new growth, and excluded mere enlargements of 
natural parts. He divided tumors into several 
genera, the first genus being sarcoma to which he 
devoted the greater part of his study. He 
adopted this ancient word to designate those 
growths having a " fleshy feel," and recognised 
eight species: 

I. Common vascular sarcoma; 2. Adipose sar- 



* John Abernethy ; Surgical Observations. Containing "An 
attempt to form a classification of tumors according to their 
anatomical structure." London 1804. 



342 NEOPLASMS. 

coma ; 3. Pancreatic sarcoma ; 4. Cystic sar- 
coma ; 5. Mammary sarcoma ; 6. Tuberculous 
sarcoma ; 7. Medullary sarcoma ; 8. Carcinoma- 
tous sarcoma. 

One genus included osseous and cartilaginous 
tumors. Another genus the cysts. 

Then followed the labors of Lawrence who re- 
moved from the category of cancer " benign 
fungus" of the testicle, of Sir Everard Home 
who regarded the so called scirrhus of the pros- 
trate as simply a general or partial enlargement 
of that body, and of Sir Astley Cooper who ex- 
cluded from the class of cancers certain enchon- 
dromata, tubercles of the testicle, etc. 

Cruveilhier, Rokitanski, Velpeau, Walshe, and 
others of their day, contributed largely to the 
literature and knowledge of tumors, but that 
which afforded the greatest aid in their study was 
the advent of the cell-doctrine of Raspail (1825) 
and Royer-Collard (1826-28), rendered possible 
by the application of the compound achromatic 
microscope (1824) to the study of the human 
tissues in health and disease. Most of the old 
questions so long in debate were then surren- 
dered for what became tangible and visible. 
From that time many entered the new field of in- 
vestigation and there soon appeared exhaustive 
works on normal and pathohistology, among 



NEOPLASMS. 343 

which may be cited those of Mandl, Hassall, 
Lebert, Wedl, Vogel and Kolliker. Finally 
Virchow's cellular pathology came as a beacon 
to give the brighter light that guided the patho- 
anatomist in the right direction to further re- 
search. Cohnheim's publications represent the 
advances which Virchow's labors had suggested, 
and the recent discoveries in embryogeny now 
come to sustain the modern school of patho- 
histology and serve to explain and strengthen 
Miiller's aphorism, propounded in 1838, and 
adopted by this school, to the effect that the sub- 
stance of all tumors has its analogue in some 
tissue existing normally in embryonic or after- 
life.* This is known as the law of Miiller. 

Virchow, who published his lectures on tu- 
mors long before the views of Waldeyer and 
Duval were known, adopted the law of Miiller, 
and constructed the following arrangement of 
4< tumors," dividing them into four groups. 

1. Tumors formed at the expense of the ele- 
ments of the blood, for example haematomata, etc. 

2. Tumors formed by the retention of the pro- 



* In 1804 Laenec had recognised some tumors having an- 
alogues among the normal tissues, but Miiller advanced a step 
farther in declaring that the substance of all tumors has its 
analogue in the normal economy. 



344 NEOPLASMS. 

ducts of secretion, those which result from the 
dilation of secreting cavities, due to retention of 
the product of secretion of the glands, for exam- 
ple, glandular cysts, hygromata, etc. 

3. Tumors which result from the proliferation 
of the elements of the primitive tissues of the 
organism. This class is divided into histioid tu- 
mors formed by a single tissue, organoid tumors, 
which reproduce the configuration of an organ, 
and teratoid tumors, resembling by the assemblage 
of different organs, an incomplete being. Each 
of these classes is itself divided and sub-divided. 

4. The fourth group comprises mixed tumors, 
composed of the elements of several of the pre- 
ceding tumors. 

The high reputation of this great Master in 
pathoanatomy has caused his nomenclature and 
classification of tumors to be largely accepted by 
the profession without question. This classifica- 
tion answered a good purpose twenty -five years 
ago, and was a forward step, but the advances 
since made in pathohistology forbid its continued 
use. Nevertheless, there are many physicians 
and surgeons who still adhere to this arrange- 
ment of tumors. In the present light of science, 
probably no one sees better than Professor 
Virchow the faults of this as well as of all other 



NEOPLASMS. 345 

classifications, and if his occupations should per- 
mit him to undertake its reconstruction, he 
doubtless would do so consistently on the anat- 
omical basis which does not abrogate, but rather 
enforces, Miiller's law. He would probably aban- 
don the word tumor, and reject the haematomata 
and also the cysts. He would drop the terms 
histioid and organoid, place the teratoid growths 
under the caption terata, and make a very dif- 
ferent disposition of the mixed growths of his 
fourth group. 

Forster has arranged tumors into three groups 
as follows : 

i. " Tumors formed of a simple tissue, and 
sometimes even of a single element of this tissue; 
for example, fibroma, osteoma, etc. 

2. " Tumors having a complex arrangement, 
the analogue of which can be found in the 
economy : for example, papilloma, cyst. 

3. " Tumors formed of cells having their an- 
alogues in the economy, but arranged in a man- 
ner other than physiological. This group in- 
cludes sarcoma, carcinoma, epithelioma, lym- 
phatic tumors, under which may be classed the 
organic lesions of typhoid fever, tubercle, syphil- 
itic gummata, and true lymphoma," 

This arrangement is confusing and unsatisfac- 
tory, for genera belonging to entirely different 



34^ NEOPLASMS. 

orders are grouped together, and lesions of 
typhoid fever, tubercle, and syphilitic gummata 
are included among tumors and placed in the 
third group amidst pathic conditions to which 
they bear no relationship. 

Broca,* in his classification, goes back to 
Laenec's two categories : homologous and hete- 
rologous tumors, and begins with the following 
propositions : 

" i. All heteromorphous tumors are heterolog- 
ous. Ex. : cancers ; 

" 2. All homologous tumors are homoeomorph- 
ous. Ex. : lipomata ; 

" 3. There exists a third category of tumors 
which are at the same time homoeomorphous 
and heterologous. Ex. : epitheliomata. 

" Therefore all accidental productions may be 
divided as follows : 

" 1. Heteromorphous tumors. 

" 2. Homoeomorphous tumors : a, heterolog- 
ous ; b, homologous. 

He includes in his classification of "accidental 
productions " many morbid states which do not 
properly belong to the class tumors as the follow- 
ing synopsis will show. 



* Traittde Tumeurs," Paris 1866. Vol. I. 



broca's synopsis. 347 

Broca's classification of the 
"accidental productions." 
CLASS I.— Homoeomorphous Productions. 
Divided into: Homologues, ist sub-class; 
Heterologues, 2nd sub-class. 

Sub-class I. — Homoeomorphous and homologous 

productions. 

Divided into two orders : A. Accidental productions 

formed by the hypertrophic development of the organs 

or of their elements. B. Accidental productions of new 

formation. 

A. Accidental productions formed by the 
hypertrophic development of the organs or of 
their elements. 

I. Hypertrophy affecting at the same time, and 
in a manner about uniform, all the elements of 
the organ: Simple, general, or regular hyper- 
trophy. 

-6 f Hypertrophy of the glands, lymphatic glands, mus- 
| cles, heart, mucous membranes, skin, sub-cutaneous 
'jg \ cellular tissue {elephantiasis), bones (hyperostosis), 
3 J of certain organs such as the clitoris, the labia 
tj ^ minora, the tongue, etc. 



a. 
o 



a. 
X 

a 



Of the muscles (very rare), tendons (nodus), epi- 
dermis (corns, callosities), skin and sub-cutaneous 
cellular tissue (pedunculated elephantiasic tumors), 
mucous membranes and sub-mucous cellular tissue 
(mucous polypi, condylomata, hypertrophy of the 
pylorus, etc.). 



348 



broca's synopsis. 



2. Hypertrophy affecting unequally the several 
elements of a complex organ, one of these ele- 
ments often developing itself at the expense of 
the others : Partial or irregular hypertrophy. 



JJ f Occupying particularly the papillae (warts). 

^ c I Occupying certain parts of the derma (con- 

0*^ I dylomata). Occuping the sebaceous or the sud- 

^ I oriparous glands. 






Occupying the papillae (cauliflower vegetations 

of the external genital organs, of the cervix uteri, 

^ of the maxillary sinus, etc., granulations of the 



c £ J conjunctiva ?). 
D g [ Occupying the mucous glands and follicles. 



to 

jg I 



fcJO 



a. Irregular hypertrophy occupying a part or 
all of the lobes of an acinous gland (uniglandular 
adenoma or adenoid tumor) of Velpeau. 

b. Hypertrophy occupying many small glands 
■{ comprised in the same region. Transition to 

heterology (multiglandular adenomata, polyade- 
nomata or glandular cancroids of the sebaceous, 
sudoriparous, uterine, labial, and rectal glands, 
etc.). 



broca's synopsis. 349 

B. Homocomorphous and Homologous pro- 
ductions of new formation. 

That may be divided into two groups, accord- 
ing as their autogenous elements are compound 
or simple. 



f a. Tumors formed 
principally of vessels 
or of sanguineous cavi- 
ties whose parieties are 
similar to the parieties 
of the vessels. 



C o 



b. Tumors formed of ^ 
a tissue analogous to j 
that of the uterus, that I ^ o <S 
is to say of fibrous [ x £ g 
tissue and of fibro- 
muscular cells. 



c. Tumors formed of 
one or of several ho- 
moeomorphous and ho- 
mologous membranes, f .>> 
which circumscribe one 
or several cavities. 



\ Arterial. 
) Venous. 



Fibrous tumors of 
the uterus and of the 
neighboring regions. 



{ I. Cysts developed 
in preexisting cavities 
(progenetic cysts). 

2. Cysts of entirely 
new formation (neo- 



[ genetic cysts). 



d. Tumors formed of) 
the transitory or defin- ( riJ^-^«.«*- 
itive tissues of the f 0dontomata - 
[teeth. J 



35o 



BROCAS SYNOPSIS. 



f a. of adipose t a. Diffuse. — Fatty infiltration of the organs. 
tissue \ b. Circumscribed. — Lipomata. 



c 
<u 

B 

<u 

'5, 
£ 
i/5 

■ffl 



b. of osseous 
tissue 



a. 



Reparative ossifi- 
cation 



lor 



Callus, new bone 
necrosis, etc. 



b - Idi0 S,?„1 Osteoma 



1. In con- 
tinuity with 
the bone 
(exostoses 
and osteo- 
phytes). 

2. With- 
out conti- 
nuity with 
the bone 
(free bony 

. tumors). 

j c. of cartilaginous t Of the skeleton, 

tissue chondromata ] Of the soft parts. 

Cicatrices. In- 
flammatory indu- 
ration. Organized 
d. of fibrous or f a. Productions <( false membranes. 

Fibrous knobs of 
nerve trunks after 



connective tissue 
or of fibro-plastic 
elements, transi- 
tory, passing 
promptly into the 
fibrous state. 



of traumatic or of 
inflammatory ori- 
gin. 



[ amputation. 



b. Idiopathic produc- ) 

- > Fibromata. 



tions forming < 
scribed tumors. 



e. Epithelial elements, forming a 
particular tissue, without mixture 
of other elements. Transition to 
, heterology. j 



Horns. 



broca's synopsis. 351 

Sub-class II. — Homoeomorphous and heterologous 
productions. 

I Fibrous and fibro^ 
t.c elements in about equal Anat0 X mical luberC ulous tumors, 
proportions Certain f } of ^ dufa mater 



2. Autogenous and permanent fibro-plastic ele- ( nuclear, 
ments Fibroids. \ fibrillary. 



of the skin. 

Epithelioma. ) of the muco, 
v f membranes. 



1 ^ L V,'._- 5 of tl 
( me 



4. Disks with multiple nuclei or myeloplaxes ) Myeloids 
forming the autogenous element \ ' 



Simple melanosis 
5. Autogenous pigmentary elements. <{ (rare in man, com- 
mon in the horse). 



-i 



6. Elements of entirely new formation ) Pseudadenomata 
imitating the form of glandular culs-de- > (or heteradeno- 
sac, but forming a heterologous tissue. . . ) mata.) 



352 broca's synopsis. 

CLASS II. — Heteromorphous Productions 
(all are heterologous). 

A. Accidental productions forming part of the 
economy. 

i. Tumors of a high organization, and of a greater or 
less vascularity of their own, containing specific ele- 
ments called cancerous elements, pure or mixed with 
adventitious elements : Cancers. 

2. Tumors of a much lower organization, deprived of 
vessels and containing specific elements called tuber- 
culous elements : Tubercles. 

B. Accidental heteromorphous production 
which does not form a part of the economy: 
Pus. 

CLASS III. — Amorphous Productions. 

' of gelatiniform matter Simple colloid. 

of very small corpuscles which belong neither ) Syphilitic 
to nuclei nor to cells \ gummata. 

t: of coagulated fibrin, without ( *_*•___ ^„ f( , „ ( t * „„ 
52 i * j . cu „ cu > Active clots of the ar- 

I] SSSyLte." fl^i teriesorofaneurysm, 

of fat granules, cholesterin crys- ) Cretad ather om a - 

tals, sundry crystals, and cal- I d 

sai r ts° US . an . ... . m .°. r . ganlC J *&* de P° sits ' * c ' 

CLASS IV. — Encysted Parasitic Animals. 
Hydatids. 



NEOPLASMS. 353 

Cornil and Ranvier make some improvement 
on the preceding arrangements, but instead of 
gathering together like genera, they rank as or- 
ders several of these genera. They divide the 
" tumors " into ten groups as follows : * 

Group I. — " Comprises tumors formed of a 
tissue analogous to embryonic tissue. We might 
employ a new word to indicate this analogy, but 
we prefer to make use of the old word sarcoma, 
though it has been employed in very different 
senses by different authors. This group only 
contains one genus, sarcoma, of which there are 
a great number of species and varieties. 

Group II. — "Contains tumors formed of a tis- 
sue, the type of which is found in connective 
tissue. This tissue is sometimes mucous, and 
the tumor is called myxoma, sometimes fibrous 
and called fibroma (Verneuil), or inoma, from 
t'ros, fibre (Paget), sometimes adipose, when 
called lipoma. In some cases the tissue under- 
goes hypertrophic aberration affecting the size of 
the cells ; this is the case in carcinoma, which 



* Cornil and Ranvier. Manual of Pathological Histology, 
second edition. Translated by A. M. Hart. London 1882. No 
change in Cornil and Ranvier's classification of tumors has 
been made since their first edition which was published in 
1869. 



354 NEOPLASMS. 

would be better called alveolar fibroma ; in 
others, the cells atrophy, as in tubercle, glanders 
and syphilitic gummata. This second group 
therefore contains the varieties myxoma, fibroma, 
lipoma, carcinoma, tubercle, glanders, and syphil- 
itic gummata. 

Group III. — "Contains tumors formed of car- 
tilaginous tissue, of which there is but one genus, 
chondroma. 

Group IV. — " Is composed of tumors formed 
of osseous tissue, osteoma. 

Group V. — " Tumors, formed of muscular tis- 
sue or myoma, are divided into two kinds, ac- 
cording as the fibres of new formations are 
striated or non-striated : myoma of striated fibres, 
myoma of non-striated fibres. 

Group VI. — "Tumors formed of nervous tis- 
sue are of two varieties : the medullary neuroma 
containing nerve cells, and the fasciculated 
neuroma containing nerve tubes. 

Group VII. — u In this are tumors formed of 
blood-vessels, or angioma. 

Group VIII. — " Contains tumors composed of 
lymphatic vessels, lymphangioma, and those 
which reproduce the structure of lymphatic 
glands, lymphadenoma. 

Group IX. — " Contains tumors composed of 



NEOPLASMS. 355 

epithelium of new formation. They are divided 
into four varieties according as the cells are ar- 
ranged in irregular masses, epithelioma, or in 
papillae, papilloma, or in culs-de-sac, adenoma, or 
in cavities of new formation, cysts. 

Group X. —Contains mixed tumors, containing 
a great number of tissues ; they are found 
specially during intra-uterine life." 

Cornil and Ranvier* say "We wish to 

treat simply from the histological point of view, 
and have therefore included under the head of 
inflammation and haemorrhage what seemed to 
us to rightly belong to them, blood-tumors, hy- 
gromata, for example. We also think we have a 
right to reproach Virchow with having invented 
new words, drawn from gross physical characters, 
whereby to designate certain tumors, instead of 
employing words representative of the tissues. 
Thus he uses the word psammoma to signify a 
tumor of the meninges, because it contains cal- 
careous granules similar to fine sand, and the 
word glioma is applied to tumors of the brain 
because they are of a consistency analogous to 
glue. He thus departs from the classification 
which Miiller's law suggests, and which we in- 
tend to follow absolutely." 



* Op. tit. pp. 123-124. 



356 NEOPLASMS. 

At page 125, the same authors write: "The 
classification of tumors which we propose differs r 
it will be seen, notably from those hitherto pub- 
lished. It is an anatomical classification. It can- 
not consequently serve to determine the degree 
of gravity of a tumor. No anatomical classifica- 
tion can at present answer this legitimate desire 
of the physician. To determine the degree of 
gravity of a tumor, knowledge of the order, 
species, and variety to which it belongs can alone 
be depended upon. The sole general considera 
tion, which may be advanced on the subject of 
the benignity or malignity of tumors, is that the 
most serious are those which determine the 
formation of a large quantity of embryonic ele- 
ments, at the expense of which they grow 
rapidly. Our classification has the advantage of 
being purely histological and of being based on 
one law and on one consideration which seems to 
us to be supreme, that is, the general arrange- 
ment of the morbid tissue and the distribution of 
the elements composing it." 

Cornil and Ranvier, adopting the aphorism of 
Miiller, endeavor to conduct their classification 
on the anatomical basis, but even at the beginning 
are inconsistent, for instead of grouping the tu- 
mors in accordance with the histogeny of the 
tissues, they mix connective tissue with epithelial 



NEOPLASMS. 357 

growths ; thus they place in group second, in- 
oma, myxoma, lipoma (connective tissue growths), 
with carcinoma (epithelial growth), and then add 
tubercle, glanders, and syphilitic gummata, which 
have no legitimate place in this group. Instead 
of placing in one and the same group, sarcoma, 
myxoma, inoma, lipoma, chondroma, and os- 
teoma, which are all connective tissue growths, 
they scatter them in four distinct groups. 

They make varieties of medullary and fasci- 
culated neuromata which are in reality species ; 
and epithelioma and adenoma which are genera 
are also set down as varieties. 

They class papilloma as a variety of epithelial 
growth, while in truth it is a papillary or villous 
inoma, and should be so named and not called 
papilloma. They include too the cysts, which 
should be placed under a distinct and separate 
caption. 

The mixed tumors, described by them as 
formed especially during intra-uterine life, belong 
properly to the teratisms and should be classified 
accordingly. 

This all shows how inconsistent and fallible 
men can be ; even those whose minds are richly 
stored with knowledge. Therefore nothing in 
medicine should be taken for granted because ut- 
tered by one high authority. Every assertion, 



358 NEOPLASMS. 

theory, discovery, and new method or process, 
should be put to the most searching tests by 
many laborers, and, before they are accepted, 
should pass through the expurgating crucible of 
criticism which will clear away the dross of 
error and misconception, and bring forth the 
genuine glitter of the pure and precious truths 
of science. This is the right path to advancement. 
Hasse thinks that neoplasms probably arise in 
tissues in different conditions — embryonic, grow- 
ing, mature, retrogressive. They are regarded as 
new formations because they are more or less in- 
dependent of the matrix tissue. They behave 
like independent, isolated bodies, except that they 
draw their sustenance from the organism ; they 
have their autonomy, so that they bear no relative 
increase or decrease of size with the organism. 
Examples: A neoplasm, in a fat subject, does not 
decrease in size upon the supervention of emacia- 
tion ; and a neoplasm, in a lean subject, does not 
increase in size upon the supervention of cor- 
pulency. " The neoplasm assumes properties 
distinct from its surroundings, the individual ele- 
ments of the growth become affected in some 
way and they are rendered dissimilar to their 
neighbors. There is no limiting or directing in- 
fluence of the surrounding tissues on the new 
growth. The result is development of a tissue of 



NEOPLASMS. 359 

abnormal type, a local anatomical misforma- 
tion." 

Cohnheim is of opinion that neoplasms cannot 
be regarded as localised hyperplasias because 
they generally differ in their histogenesis from 
the matrix tissue, and because this histogenesis is 
so different from the formative processes orig- 
inating in inflammation. His views of the em- 
bryonic theory are substantially as follows : 
Many forms of neoplasms are developed at all 
ages, they originate too in apparently normal 
tissues, and are due to the persistence of embry- 
onic germinal tissues in the otherwise mature 
organism ; taking their rise in what may be 
called belated rudiments — foci of formative em- 
bryonic tissue which have not been utilised in 
elaborating normal tissues, and so have lingered 
on unchanged. In other words such a growth is 
an atypical new-formation starting in a latent 
embryonic rudiment. The germs of the growth 
may be very small and elude observation, being 
embryonic cells, or may be quite recognisable 
among the normal elements. These germs may 
long remain inactive, but when external condi- 
tions, supply of nutriment, and relation to sur- 
rounding tissues are favorable, they begin to 
multiply, start into a new life and form a neo- 



360 NEOPLASMS 

plasm.* Cohnheim's arguments in favor of his 
theory have explained the otherwise unaccount- 
able heterogeny of many neoplasms. He says : 
many new-growths are hereditary ; they may 
exist at birth or develop in infancy ; they show a 
preference for sites where, in early develop- 
mental stages, complication of structure happens ; 
where different epithelial formations pass one 
into the other, as the lips, stomach, anus, and 
cervix uteri ; or where the entire process of de- 
velopment is complex, as the genital apparatus ; 
also the atypical structures. 

In order to fully understand the blastodermic 
theory of the development of neoplasms, it is 
necessary to pass in review the changes which 
take place in the human blastoderm. The follow- 
ing, which exposes the most recent views of the 
subject, is abstracted from Duval's physiology. 

" Originally the human organism consisted of 
a single cell, the ovule, which when fecundated 
begins to undergo certain transformations, the 
first of which being segmentation. As soon as 
the ovule is divided in four segments, these limit 
between themselves, by their slight separation, a 
space called the segmentation cavity. As the 



* It is well known how often new-growths take their start- 
ing point from traumatisms. 



NEOPLASMS. 361 

segmentation goes on, this cavity increases more 
and more, and finally the segmented ovule be- 
comes a hollow sphere whose parieties are con- 
stituted by a layer of cells comparable to epithelia. 
The large cavity circumscribed by this layer of 
cells still bears the name of segmentation cavity. 
Then take place transformations which differ 
somewhat in different animals, but may neverthe- 
less be brought to the following type : that is to 
say to the formation of a gastrula. One of the 
hemispheres of the hollow sphere becomes flat, 
then is gradually invaginated in the interior of 
the other hemisphere. A new cavity, called the 
invagination or gastrula cavity, is thus produced, 
which corresponds to the future intestinal cavity. 
" The segmentation cavity is then reduced to a 
mere chink separating two cellular layers : the one 
of the layers, which corresponds to the interior of 
the original intact hemisphere of the hollow 
sphere, is called the external layer, the other, 
which corresponds to the interior of the invagi- 
nated hemisphere is called the internal layer. 
Soon the internal layer, by multiplication of its 
cells, is divided into two layers, one of which be- 
ing the internal layer proper, and the other the 
middle layer or mesoblast. The mesoblast there- 
fore occupies a position, in what was the segmen- 
tation cavity, between the internal and external 



362 NEOPLASMS. 

layers. Such is the origin and development of the 
blastodermic vesicle, and such are the relations 
of its three layers. The epiblast or external 
horny layer retains its cellular character, and 
from it is derived the epidermis. 

" The entoblast or internal layer furnishes the 
epithelium of the future intestinal raucous mem- 
brane and of that of its annexes, of the great 
majority of glands, and of the lungs. 

" The mesoblast or middle layer. The cells of 
of this layer undergo much more complicated 
transformations than those of the other two 
layers. Some of them are transformed into nerve 
tissue, into muscle tissue, and into all the forms 
of connective tissue ; others preserve their cellu- 
lar state, but are changed in form and diffused in 
the fibrous element of connective tissue, " they 
are called embryonic or mesoblastic cells — cells 
of tendous, cartilage, bone — ; the others swim in 
a fluid — blood cells, etc." * 

Rindfleisch and Lancereaux based their classi- 
fications of the new-growths upon the derivative 
tissues of the blastoderm, and divided these new- 
growths into two great classes ; (1,) that in which 
the generative tissue is derived from the meso- 



* Mathias Duval. Cours de Pysiologie. Sixieme edition. 
Paris, 1887. 



NEOPLASMS. 363 

blast ; (2,) that in which the generative tissue is 
derived from the entoblast and epiblast. The 
first being formed of connective tissue, the second 
of epithelium, of epidermis, or of their derivatives. 
Hallopeau adopted this basis of classification in 
the first edition of his work, but in the second 
edition he says: "to-day the soundness of this 
division may be doubted in view of the late em- 
bryogenic researches of Waldeyer, showing that 
the entoblast and mesoblast are derived from the 
invagination of the epiblast; in that case the 
mesoblast has not the same individuality as the 
others, for, elements of different nature are 
therein united. Duval had arrived independently 
at the same conclusion. 

In his work on Physiological Chemistry (1880), 
Gamgee, in treating of the epithelium of the 
mucous membranes, says : 

" This epithelium is mainly derived from the 
hypoblast, though in some cases it takes its 
origin in the epiblast (epithelium of mouth and 
salivary glands), in others from the mesoblast 
(certain portions of the epithelium of the genito- 
urinary tract). In short, the epithelium of the 
mucous membranes is possessed of diverse chem- 
ical attributes and is developed in several ways ; 
it does not therefore possess any common charac- 
ters which permit of a general description." 



364 NEOPLASMS. 

The clinical basis is out of the question because, 
if an arrangement were attempted on such a 
foundation, the malignant and non-malignant 
growths would have to appear under separate 
heads ; for instance, epithelioma and carcinoma 
would have to be placed in the same order as 
sarcoma, etc. It would be against all rules of 
nosography to arrange growths in accordance 
with their benignity or malignity, for this belongs 
to prognosis which occupies its proper rank in 
methodical arrangement. 

Rindfleisch still adheres to the blastodermic 
basis,* and defines a tumor as " an excess of de- 
generative local development." 

The classification which he now promulgates 
is based upon the duality of the embryonic ele- 
ments (His.), namely, (1,) archiblastic tissues, 
which, besides the epithelial casing of the epiblast 
and entoblast, include the muscular and nervous 
elements that are generally credited to the meso- 
blast ; (2,) the parablastic tissues, the products of 
the peripheric vessel-forming matrix, of the area 
opaca of the embryo, which from the periphery 
grow into archiblastic layers, and serve to bind 
them together and nourish them. If, says Rind- 



* Ed. Rindfleisch. Elements de Pathologie. Traduction 
Franchise du Docteur J. Schmitt. Paris 1886. 



NEOPLASMS. 365 

fleisch, this theory be accepted, a natural and 
fruitful division of tumors may be made into two 
groups: "The first group include tumors 
which are exclusively the products of the inter- 
mediary apparatus of nutrition — the primitive 
parablasts. From the beginning they show their 
connection with the vascular system, by forming 
around a vessel a little focus of embryonic tissue 
rich in cells. This may in time produce the high- 
est types of the tissues of the parablastic series. 
After this manner are produced lipoma, fibroma, 
myoma, enchondroma, endothelioma, angioma, 
etc. But in a great number of cases the neoplasm 
does not reach full development, and the tumor 
remains formed of an imperfect connective tissue 
such as is found in inflammatory neoplasms — 
connective tissue with round or fusiform cells — 
this is sarcoma. This imperfect maturation of 
tissue gives a new criterion of the degree of de- 
generation, and irregularity of development. In 
fact the amount of production is in inverse ratio 
to the perfectness of the tissue. The excessive 
formative activity seems to have the one object 
of producing an enormous amount of cells. It is 
in this way that the disease destroys an organ 
and pervades the whole economy. In this strug- 
gle, the individual development of the cell goes 
on with difficulty. Still the most exuberant sar- 



366 NEOPLASMS. 

comata have a tendency to reproduce certain 
characters of the site where they are developed — 
as ossification, pigmentation, etc. 

"The second group includes the epithelial tu. 
mors. Here the epiblast and entoblast, either 
alone or mixed with the parablasts, determine 
the essential nature of the tumor. Here too are 
produced many young epithelial cells which 
rarely reach full development but resemble the 
epithelial cells which are proper to the site. 
Thus are formed the subdivisions of adenomata. 
Much more frequent are the true carcinomata in 
which the epithelial proliferation is completely 
atypical and very rapid and abundant, the young 
cells inordinately accumulating on the chosen 
ground. Carcinomata and sarcomata, in conse- 
quence of this luxuriant cell proliferation, have a 
common property which allows them to be in- 
cluded in the same clinical group as that of 
medullary tumors." 

It is thus Rindfleisch reaches his classification 
which is as follows : 



neoplasms. 367 

Rindfleisch's Classification of Tumors. 

Group I. Hyperplastic Tumors. 
Site; Bone, Skin, Glands. 

1. Enchondrosis 

2. Exostosis 

3. Verruca 

4. Papilloma 

5. Hypertrophied glands with equal develop- 

ment of all their tissues. 

a. Lymphoma (lymph-glands, spleen). 

b. Struma hyperplastica (thymus, prostate). 

c. Cysts by retention (atheroma, mucous polyps 

of the intestines and uterus).* 

Group II. Heteroplastic Tumors. 
(True tumors). 

A. Tumors issued from the vasculo-connective 
substance — Parablastic ?teoplasms (His). Histioid 
tumors (Virchow). 



* Here then is a series of growths which Rindfleisch classi- 
fies as tumors, but in the second group (true tumors), is an 
implied statement that the first group consists of tumors that 
are not tumors. This, however, is but a venial fault as com- 
pared with others contained in this very unsatisfactory classi- 
fication. 



368 NEOPLASMS. 

a. Where the tissues reach perfect maturation. 
i. Fibroma 

2. Lipoma 

3. Enchondroma 

4. Myxoma 

5. Angioma 

6. Osteoma 

7. Endothelioma. 

b. Where the tissues do not reach perfect 
maturation. 

1. Sarcoma 

a. Fusocellular sarcoma (small cells). 

b. Fusocellular sarcoma (large cells). 

c. Simple globocellular sarcoma. 

d. Lymphadenoid globocellular sarcoma. 

B. Tumors having their origin in the tegu- 
mentary or glandular epithelium (archiblastic 
heteroplasms). 

1. Epithelioma 

a. Pavement epithelium tumors, 

b. Cylindrical epithelium tumors. 

c. Glandular epithelium tumors. 

There stops this new arrangement of tumors. 
It is so obviously incomplete, inconsistent, and 
unsatisfactory that an extended commentary 
thereon would be superfluous. 



NEOPLASMS. 



369 



Mr. Butlin, excluding the cysts, divides tumors 
into two orders and fourteen genera as follows:* 



I. Connective 
tissue tumors. 



1. Lipoma 

2. Fibroma 

3. Chondroma 

4. Osteoma 

5. Myxoma 

6. Lymphoma 

7. Myoma 

8. Neuroma 

9. Angeioma 

10. Sarcoma 

11. Endothelioma 



II. Epithelial] I3 - P a P illoma 

■< 13. Adenoma 

( 14. Carcinoma, 



tumors. 



Six modern classifications of tumors — all dif- 
ferent — , from Virchow to Butlin and Rindfleisch, 
are given for comparison. If, in the whole range 
of nosography, there existed only this diversity 
in arrangement, it would be sufficient to warrant 
a loud call for a better understanding among in- 
vestigators, for associated labor, and for a general 
consense of views in the profession, as the only 
means to put an end to this confusion of names 



* Article Tumors, by Henry Trentham Butlin, F. R. C. S. 
in the International Encyclopedia of Surgery, 1884. 



370 NEOPLASMS. 

whose outcome has been confusion of ideas. 
Only one classification of tumors is really wanted 
and this should be compiled, partly from those 
now existing 1 , and partly from the new material 
which must come forth as a result of the study 
entailed by such compilation. 

The foregoing statements render it clear that 
the law of Miiller, or the blastodermic theory 
cannot stand for the foundation of any classifica- 
tion. However, neither the former nor the latter 
should be lost sight of, for they both afford great 
aid alike in the study of morbid growths and in 
their arrangement. The true basis of the classi- 
fication should be anatomy in its broadest, most 
comprehensive sense, leading from biogeny to 
pathogeny. Tt is upon this basis, in accordance 
with the dominant structure in their composition, 
that the arrangement of neoplasms, (as far as 
genera), has been made in the table of morbid 
states and morbific processes, which is offered 
only as a suggestion of a ground-work for the 
classification of diseases. 

In the table of morbid states and morbific pro- 
cesses Neoplasmata stand for class, and this class 
is divided into five orders : i, Desmoneoplas- 
mata ; 2, Myoneoplasmata ; 3, Neuroneoplas- 
mata; 4, Angioneoplasmata ; and 5, Epithelioneo- 
plasmata : and fourteen genera. Thus indicating 



NEOPLASMS. 371 

the tissues of which the growths are chiefly com- 
posed. 

The first order consists of eight genera ; the 
second order, of one genus ; the third order, of 
one genus ; the fourth order, of one genus ; and 
the fifth order, of three genera. 

The third genus of the first order is named 
inoma, — from i's, zVo?, fibre — , as suggested long 
ago by Sir James Paget. This term is preferable 
to, because more exact than, fibroma which is a 
hybrid. However, in the table it appears in 
brackets. 

The fifth genus of this first order is named 
neuroglioma instead of the original glioma of 
Virchow. Neuroglioma was used by Klebs, 
Heller, and Renaut (1885). They employed this 
word because they thought that the growth con- 
tained nerve elements. Ziegler and others de- 
nied that neurogliomata contain nerve elements. 
Hallopeau insists upon the use of glioma because, 
as he says, it contains no nerve elements. 

The term neuroglioma is used here simply be- 
cause the growth it is intended to designate is 
composed of neuroglia, nerve-glue. Used in such 
a sense this word will surely not indicate that the 
growth in question contains nerve elements other 
than nerve-glue. Glioma is objectionable because 



372 NEOPLASMS. 

it means a growth composed of glue without in- 
dicating the kind of glue. 

The second order, myoneoplasmata, consists of 
only one genus, myoma, and this genus of two 
species, (i,) rhabdomyoma, composed chiefly of 
striated muscular fibres, and (2,) leiomyoma, 
composed chiefly of smooth muscular tissue. 

The third order, neuroneoplasmata, consists of 
one genus, neuroma, and this genus of two spe- 
cies, (1,) medullary neuroma, containing nerve 
cells ; (2,) fasciculated neuroma, containing nerve 
tubes. 

The fourth order, angioneoplasmata, consists 
of one genus, angioma, and this genus of two 
species, (1,) haemangioma, composed chiefly of 
blood vessels ; (2,) lymphangioma, composed 
chiefly of lymph vessels. 

The fifth order, epithelioneoplasmata, consists 
of three genera, (1,) epithelioma, (2,) carcinoma, 
(3,) adenoma. Each genus has its species and 
these their varieties. Some of these species are 
now in dispute, and it is hoped that the question 
of their retention or rejection will very soon be 
settled. The epithelioneoplasmata may be said 
to be panblastic,* that is to say that they are de- 



* Panblastic (Clymer). 



BLASTOMATA. 373 

rived from the meso and from the ento and epi- 
blast. 

VI. BLASTOMATA. 

The reasons for suggesting the term blastoma 
are given at page 58. 

Blastomata are detached from neoplasmata, be- 
cause of the fact that neoplasmata spring from 
the normal tissues of the body generally without 
the intervention of extraneous substances, while 
the blastomata are now all regarded as infective 
in character and as proceeding from parasitic 
invasion. From the point of view of the Bacteri- 
ologists, blastomata have a better right to the ti- 
tle neoplasmata than the growths now bearing 
that name. In the one case the growths are en- 
dogenous (native), in the other exogenous, (for- 
eign invaders compelling the organism to build 
their dwellings which they consume and de- 
stroy.) 

The seventh genus of blastomata, actinomy- 
cosis, is a disease of the lower animals, but it oc- 
casionally invades the human body. The para- 
sites actinomyces enter the body with the food 
taken, and effect lodgment in the tissues of the 
mouth through an accidental abrasion, multiply, 
cause inflammation of the surrounding tissues 
and soon a neoplasm, resembling a tuberculous 



374 BLASTOMATA. 

nodule, is developed which consists chiefly of 
round cells. The neoplasm may go on increasing" 
in size or may break down and suppurate. In the 
slimy detritus little pale-yellow grains of the 
fungus may be detected. The organism may 
also occur in nodular tumors in the lungs, and 
subcutaneous and intermuscular tissues. It is 
the cause of " wooden tongue " and also of dis- 
eases which have been described, before their 
true nature was understood, as bone-canker, bone 
tubercle, osteo-sarcoma, etc., (Crookshank). 

The eighth genus of blastomata, rhinoscleroma, 
was formerly confounded with syphilis and lupus, 
but it greatly differs from them in its anatomical 
characters, and is not in the least degree con- 
trolled by antisyphilitic medication. It has been 
observed in Austria, Hungary, Italy, and Central 
America. Hebra and Kaposi described it in 
1870, and since that time, the subject has been 
largely discussed, particularly by Mikuliez, 
Frisch, Chiari, Klebs, Auspitz, Eppinger, Pel- 
lizari, Alvarez, and Rindfleisch. (Cornil and 
Babes). 

Rhinoscleroma is characterized by a thickening 
and induration of the nasal septum and mucous 
membrane, of the integument of the nose and 
lips, and of the pharyngo-laryngeal mucous mem- 
brane. It begins in the nose and finally invades 



BLASTOMATA. 375 

the other parts. It shows itself under the form 
of smooth or granulous, hard, elastic, and shiny 
nodosities of light red or gray color and painful 
under pressure. These growths extend deeply 
into the derma and slightly resemble keloides, 
showing neither hairs nor glandular mouths. The 
neighboring parts are tumefied, the nose is flat- 
tened and enlarged at its anterior extremity ; the 
wings of the nose are stiff and immovable; and 
the nasal orifices are narrowed. The upper lip 
is indurated from invasion of the disease which 
may reach the gums and buccal membrane, at 
the same time that the infection is propagating 
itself from the nasal fossae to the palatine cur- 
tain, to the pharynx and even the larynx. A 
glottic stenosis necessitating trachoeotomy may 
even be the result. The progress of rhinoscleroma 
is very slow, the primitive nodule may be four or 
five years in reaching a superficial extent of four 
or five centimetres. There are cases of fifteen 
or twenty years standing. (Cornil and Babes.) 

According to Auspitz, Alvarez, and Rind- 
fleisch, the skin in rhinoscleroma is infiltrated 
with small cells, its vessels are sclerosed and im- 
bedded in the same cells. It contains also proto- 
plasmic polynucleated giant cells, and also bac- 
teria and hyaline bodies. Alvarez has lately said 



376 cysts. 

that he is disposed to look upon these as dilated 
lymphatics rather than cellular elements. 

VII. Cysts. 

The cysts are detached from the class neoplas- 
mata because cysts that are not parasitic or tera- 
tic are not neoplastic, and the parasitic and tera- 
tic cysts should be placed respectively in the 
classes Parasiti and Terata. 

Most of the recent writers upon neoplasms ex- 
clude the cysts from the caption neoplasmata. 
A cyst is a cavity whose contents are circum- 
scribed by fibrous tissue, or some other more or 
less complex structure, with or without a lining 
of epithelium or endothelium, according to its 
genesis. 

Sir James Paget* separates the cysts from the 
tumors, but includes parasitic and teratic cysts in 
the one class cysts, as have done most other 
writers. 

Mr. Butlin f divides cysts into : 



* Lectures on Surgical Pathology, edited by Dr. Turner. 
t Loc. Cit. 



cysts. 377 

I. Cysts formed by distension of previously 
existing sacs or tubes. 

1. Retention cysts. 

2. Exudation cysts. 

3. Blood cysts. 

4. Lymph cysts. 

II. Cysts of new formation. 

1. Extravasation cysts. 

2. Parasitic cysts. 

3. Cysts formed in areolar tissue. 

4. Cysts formed by union of papillary processes. 

5. Cysts from changes in cells. 

III. Cysts of uncertain origin. 

Are not the cysts (II. 3.) formed in areolar tis- 
sue the same as (1. 2.) the exudation cysts, and 
{I. 4.) the lymph cysts ? 

Parasitic cysts have no place in II, for they be- 
long properly to the caption Parasiti. 

Cysts of uncertain origin (III,) naturally sug- 
gest that an endeavor should be made to find the 
origin of these cysts in order that they be named 
and rightly classified. 

Retention cysts are exemplified by the glandu- 
lar cysts formed, in preexisting epithelial cavi- 
ties, by organic or mechanical closure of a gland 
duct, causing an accumulation of its natural se 



378 CYSTS. 

cretion behind the obstruction, and dilatation 
into a cyst. The retention cysts occur in the 
skin, mamma, uterus, intestine, and kidney- 
Canals lined with epithelium, such as the bile 
ducts, ureters, vermiform appendix, seminal 
tubes, etc., develop into cysts by local dilatation 
from obstruction. 

Endothelial cysts are often classed as retention 
cysts, but are not of that nature. They are 
properly exudation cysts, and occur either in 
natural spaces of the connective tissue, such as 
bursae and tendon sheaths, in false membranes, 
or in obstructed lymphatics, and their contents, 
though varying with their mode of origin, consist 
generally of lymph. 

Blood cysts are due to haemorrhage in pre- 
existing cysts, in closed cavities, or in connective 
tissue which eventually encloses completely the 
extravasated blood. They are all therefore blood 
extravasation cysts. 

Lymph cysts, commonly called hygromata, are 
the same as endothelial cysts, and are the out- 
come of obstruction of lymph vessels, or of dila- 
tation of lymph spaces. They may also be lymph 
extravasation cysts. 

Degeneration cysts result from a necrotic pro- 
cess. They occur in the substance of organs and 
sometimes of tumors, and their contents are the 



cysts. 379 

products of disintegration of the substance of the 
organ or of the tumor. 

Cysts formed around foreign bodies such as 
bullets, etc., and around parasites, should be 
classed under their appropriate captions and not 
with neoplasmata. 

Waldeyer and Malassez regard ovarian cysts as 
epitheliomata. If this view be correct, such 
cysts should be classed as varieties of epithelio- 
mata. 



38o 



CONCLUSIONS. 



Among the conclusions drawn from the pre- 
ceding considerations are : 

i. That the systematic arrangement of diseases 
upon a proper basis must give to medicine an as- 
sured position among the sciences ; and that even 
in its imperfect state, it has contributed marvel- 
ously to the advancement of medical art during 
this century. 

2. That the only stable basis for nosography is 
anatomy. 

3. That an accurate description and an exact 
definition of diseases are essential to a precise 
and practical nosography. 

4. That a nomenclature, to be satisfactory, 
must not admit the application of the names of 
men to diseases, or any name which does not con- 
vey an intelligible idea of a morbid condition. 



CONCLUSIONS. 381 

5. That the nomenclature of diseases can be 
much improved only after a very great change 
for the better shall be made in the fundamental 
science and associated arts of medicine. 

6. That the most useful and practical classifica- 
tion of diseases is that in which these are grouped, 
in accordance with the apparatuses of the body, 
into families, branches of families, classes, orders, 
genera, species, sub-species, varieties, and sub- 
varieties. 

7. That the purpose of the nosographer should 
be to guide the practising physician to the 
end of any case of disease. 

8. That a complete nosography should include 
the history, pathoanatomy, diagnosis, prognosis, 
and treatment of diseases, and for ready refer- 
ence, should contain not less than five synoptical 
tables : (1,) a synposis of the morbid states and 
morbific processes of the body ; (2,) a synopsis of 
the genera and species of diseases ; (3,) a synop- 
sis of the classes, orders, genera, species, sub- 
species, varieties, and sub-varieties of diseases ; 
(4,) a synopsis of the aetical factors of diseases - r 



382 CONCLUSIONS. 

and (5,) a synopsis of the symptoms and signs of 
diseases ; also a full alphabetical index. 

9. That any system of general nosography, to 
be of utility to scientific investigators, practising 
physicians, and vital statisticians, should be the 
result of the conjoint labors of the medical pro- 
fession of all the civilized nations of the world. 




INDEX. 



383 



Abortus . 


103, 158 


Abscess 


82 


Acetonaemia 


46, 264 


Achores 


82 


Acrotica 


161 


Acrotismus 


152 


Actinomycosis 


49. 373 


Adenoma 


49 


Adenoses 


165 


Adipsia 


99. ii4 


Adynamiae . . 


108, in, 126 


Aedopsophia 


104 


Aedoptosis 


157 


Aerifluxus 


104 


Aesthetica 


149 


Agenesia . . 


. 156 


Ageustia 


114 


Agheustia 


98 


Agrypnia 


. 102, 153 


Algor . . 


100 


Alibert's System 


165 


Alopecia 


82, 106 


Alphosis 


164 


Alusia . . • . 


148 


Alvifluxus, 


103 


Amaurosis 


98, 113, 150 


Amblyopia 


98 


Amenorrhoea 


115 



Amentia 


iflUfiA. 


1 02, 112 


American Med. Assoc. 


discussion o 


n the adoption 


of a system of nomenclature, 


176 


Ammoniaemia 


. , 


46, 264 


Amnesia 




102 


Amphimerina 


. 


95 


Amputatura 




94 


Anacatharsis 


. 


103 


Anaesthesia 




98, 114 


Anaphrodisia, 


. 


99>H4 


Anasarca 




82, 104, 112 


Anatomy 


. 


3i 


Anchylosis 




82 


Anepithymiae 


. 


99. 127 


Anetus . 




139 


Aneurysma . 


. . 


92,115,147 


Angina . 




98 


Angioma 


. 


49 


Angioses 




. 165 


Anhelatio 


. 


97,117,125 


Anorexia 




• 99. 1*4 


Anosmia . 


. 


98,114 


Antipathia 




102, 153 


Anthracia 


. 


145 


Anthrax 




. 92, 141 


Anthroponosography 


. 


34 


Anthropophysiography 




31 


Anxietas 


, 


. 100, 153 


Aphelxia 


• 


• , • . • H9 


Aphonia 


. 


99, 114, 136 


Aphoria 


. . 


157 


Aphorisms of Linnaeus 


. 


188 


Aphtha 


. 


83,95, IIO » J 44 



INDEX. 



385 



Apocenosis . 


. 


. 


115, 125 


Apolepsis 


. 


. 


83 


Apomyttosis 


. 


. 


97 


Apoplcxia 


. 


83, 99, 


in, 154 


Apparatus — definition of 


, 


. 


64 


Apparatus — circulatory, disturbance! 


> in 


47 


Ardor 


. , 


. 


100 


Aridura 


. 




104 


Arthritis 


. 




100, 124 


Arthrocace 


. 




94 


Arthrodynia 


. 




no 


Arthropuosis 


. 




no 


Arthrosia 


• « 


, 


144 


Ascarides 


, 




83 


Ascites 


. 




105. 113 


Asphyxia 


. 




99 


Asthenia 


, 




99 


Asthma . 


. 


. 83,98,111, 


125, 138 


Athroisaemia 


. 


. 


47. 324 


Atrophy 


. 


. 47, 52, 55. 


104, 112 


Auante 


• 1 


. 


83 


Aurigo 


. 


106, 


127, 164 


Auxesis 


. 


45 


r, 52, 326 


Azoteneses 


. 




. 119 


Bacteria 


. 


# • 


298-323 


Ballismus 


, 




• 153 


Barber-surgeon . 


. 


< • • 


41 


Basis of classification 


. 




. 214 


Baumes* system 


. 


. • . 


118 


Beriberia 


. 




97. 153 


Bex 


. 


• 


137 


Bezoardus . 


. 




• 133 


Bibliography, nosographical 




. 


200-2 i 1 



3»6 


INDEX. 






Biothalmy 


. 




37 


Blastomata 


. 




• 49- 373 


Blennoses 


• • • 


, 


. 166 


Blennorrhoea 


• • • 




155 


Blepharoptosis 


. 


. 


93 


Blood, alterations i 


a composition of 




. 45» 254 


Bronchitis 


. . • 


, 


142 


Bronchocele 


• . t 




92 


Bubo 


. 


' 83. 


92, 115, 140 


Bucnaemia 


. 




143 


Bulimia 


• . 


. 


102, 114 


Cachexiae 


83, 104, 


108, 


[12, 117, 127 


Caeliaca . 


. 


. 


. IO3 


Calculus 


. 




133 


Caligo . , 


. 




98, II3, I50 


Callus 


• • • 




163 


Calorineses 


. 


s 


. 119 


Cancer 


. . . 


83. 


92, II5.336 


Carbuncle 


. . 


. 


• 83 


Carcinoma 


. 




. 49. I05 


Carcinus 


• • • • 


, 


. I46 


Cardialgia 


• 




101, 132 


Cardiogmus 


• •••'■ 


. 


. IOO 


Carditis 


. 


96, 


[09, 123, 142 


Caries 


• • • • 




94.;n6, 147 


Carphologia 


« • • 




97 


Carpotica 


• • • • 


. 


• 157 


Caruncula 


• • • 




163 


Carus 


. . . • 


. 


83»99 


Catacausis 


. 




146 


Catalepsia 


. 


. 


• 154 


Catalepsis 


. 




99 


Cataphora 


. 


. 


83.99 



INDEX. 



387 



Catarracta 


98, 150 


Catarrhus 


100, no, 124, 143 


Catoche .... 


. 83 


Catochus 


97 


Catotica .... 


. 160 


Cenotica 


154 


Cephalaea 


100, 154 


Cephalalgia 


100 


Cephalitis . 


96, 142 


Chancroid ulcer 


49 


Chirurgery, master in 


41 


Chlorosis 


106, in, 156 


Cholaemia . 


46, 266 


Cholera . . 


84, 103, in, 133 


Cholesteraemia 


266 


Chololithus . . 


135 


Choloses . 


165 


Chondroma 


48 


Chorea 


. in,i53 


Cibaria 


132 


Cinetica 


152 


Clasis .... 


128 


Classification of medicine . 


31 


Classification . . 


212 


Classification, basis of 


214 


" , method of 


237 


■■ , need of 


213 


Claudicatio 


97 


Clavus 


. 115, 163 


Clonici generales 


97 


Clonici partiales 


97 


Clonos .... 


• • 126 


Clonus . • 


152 



388 



INDEX. 



Coeliaca 


124, 130 


Colica .... 


101, in, 132 


Coma .... 


84, 126 


Comata .... 


99,111 


Condyloma 


92 


Congestion .... 


47, 324 


Constrictoria • 


125 


Contractura 


96, 114, 126 


Contusio 


... 94 


Convulsio .... 


97, in 


Cophosis 


. 98 


Coprostasis . . , 


132 


Coryza .... 


. 84, 103, 136 


Crampus .... 


96 


Cretinismus 


. 159 


Crichton's system 


122 


Critici .... 


• . .107 


Cullen's rules 


180 


Cullen's synopsis 


109 


Cynanche .... 


96, 109, 123 


Cyrtosis 


. 159 


Cystides .... 


92 


Cystirrhoea 


124 


Cystis .... 


128 


Cysts . . 


5°, 376 


Cystitis 


96, no, 123, 142 


Cystocele 


93 


Darwin's system 


118 


Debilitates 


98,117 


Decrease .... 


48, 54 


Definition of medicine 


29 


Definitions of terms of classification 


247 


Defluxion . . . 


. 84 



INDNX. 


389 


Deformes 




108 


Deformitates 


. 


108 


Degeneration 


. 


48, 327 


Deliria .... 


. 


102 


Demens 


. 


149 


Demonomania 


. 


102 


Description and definition 


. 


226 


Desmoneoplasmata 




48, 37i 


Diabetes 


103, 


in, 125 


Dialysis 




. 128 


Diarrhoea, 


84, 103, 


in, 132 


Diastasis 




94, 129 


Dilatation 


. 


48.57 


Diplopia 




. IOI 


Dipsosis 


. 


131 


Discalorineses 




. 119 


Disease, definition of . 


. 


43 


, etymology " 




• 43 


, facies " 


. 


32 


Disorder 




. 58 


11 functional 




5i 


Disoxygeneses 




. 119 


Diuresis 


. 


125 


Dolores 


100, 


108, 117 


Dolorosi 


• . . 


107 


Dyalyses 




. 116 


Dysaesthesiae 


. • 


98, 113 


Dyscinesiae 




99. ii4 


Dysecoea 


. 


98, 113 


Dysenteria 


84, 103, no, 


124, 143 


Dysodia 


. 


104 


Dysopia 


• • • 


• 113 


Dysorexiac 


. 


114 



39° 



INDEX. 



Dyspepsia 

Dyspermatismus 

Dyspermia 

Dysphagia 

Dysphonia 

Dysphoria 

Dyspnoea 

Dysthetica 

Dystocia 

Dysuria 

Eccliymoma 

Ecchymosis 

Eccritica 

Eccyesis 

Echmasis . 

Eclampsia 

Ecphlysis 

Ecphronia 

Ecphyma 

Ecpyesis 

Ecstasis 

Ectasis 

Ecthyma 

Ectopiae 

Eczema 

Effera 

Efflorescentiae 

Elcosis 

Elephantiasis 

Embolismus 

Emesis 

Empathema 

Emphlysis 



in, 132 

104, 115, 126 
. 156 

100, 114, 125, 131 
. 137 
153 
84, 98, in, 125, 138 

145 
. 101 
84, 104, 115, 126 
91, 115 
85, 127 

• 159 
. 158 

48, 57 

97 

162 

148 

163 

. 163 

99. 154 

• 48,57 

163 

93, 116, 128, 129 

162 

95 

91. 125 

106 

105, 113, 146 
47, 326 

132 
148 
145 



INDEX. 



391 



Emphyma 


159 


Emphysema 


92, 128, 160, 142 


Emprosthotonos 


. 85 


Empyema 


85, 98, 109 


Empyesis 


. 145 


Enanthesis 


144 


Encephalocele 


93 


Endothelioma 


48 


Enecia 


140 


Enlargement 


47. 52 


Entasia 


. 152 


Enterica 


130 


Enteritis . 


96, 109, 123, 142 


Enterocele 


93 


Enterolithus 


• 133 


Enteroses 


165 


Enuresis . 


103,115 


Epanetus 


139 


Ephelis 


91, 164 


Ephemera . . . 


• 94. 139 


Ephialtes . 


97, 138 


Ephidrosis 


103, 115, 161 


Epichrosis 


164 


Epilepsia 


75. 97, in 


Epinyctides 


. 85 


Epinyctis . , 


91 


Epiphora . 


103, 115 


Epiplocele 


93 


Epiploitis 


. 96 


Epischeses 


57,108,115,125 


Epistaxis 


. no 


Epithelioma . . , 


49 


Equinia 


. 49 



392 



INDEX. 



Erotomania 

Erysipelas , 

Erythema 

Eschara 

Ethmoplecoses 

Evacuatorii 

Exangia 

Exania 

Exanthemata . 

Exanthematica 

Exanthesis 

Exarthrema 

Excoriatio 

Excrescentiae 

Exocyste 

Exomphalus , 

Exophthalmia 

Exormia 

Exostosis 

Extractives 

Exulceratio 

Faculty, definition 

Farr's system . 

Favi 

Febres 

Fibroma 

Fissura 

Fistula 

Flatus . 

Fluxus 

Foreign bodies 

Fractura 

Framboesia 



of 



85 



92, 



94. 



• 


127 


.95. 


no, 144 


92, 


124, 141 




. 94 


. 


165 




. 108 




147 




93. i34 


no, 


117, 125 


95. 


107, 144 


. 


162 




. 94 


• 


94 




. 92 


. 


93, 128 




• 93 


. 


93 




. 162 


116, 


124, 159 




. 294 


.- 


94 




. 70 


. 


174 




. 85 


108, 


109,117 




48, 37i 


. 


94 




86,94 


. 


132 




102, 117 


. 


5o 




94, 116 




105, 113 



INDEX 



Function, definition of 

Functional disorders 

Furor 

Furunculus 

Galactia 

Galactirrhoea 

Ganglion 

Gangraena 

Gangrene, humid and dry 

Gasterocele 

Gastritis 

Gastrodynia 

Gastroses 

Generic characters 

Generic names 

Genetica 

Genetic sense 

Gibbositas 

Glanders 

Glaucoma 

Glaucosis 

Glioma 

Gonorrhoea . 

Good's system 

Gout 

Graviditas 

Green sickness 

Gutta rosea 

Haeinangioma 

Haematemesis 

Haematica 

Haematuria 

Haemodiapedisis 



86. i 



96, 



393 

. 66 

51. 59 

156 
92, 141 

*55 

104 

"5 

06, 109, 147 

48 

93 

109, 123, 142 

101 

165 

. 188 

191 

• 154 

26 

9 2 

49 

86 

150 

48, 37i 
H5» 124 

130 
86 

104 
86 
91 

49. 372 
103 

139 
103, 125 

47, 325 



104, 



394 



INDEX. 



Haemoptysis 


• 


• • . 




102, no 


Haemorrhagia 




47, 86, 102, no, 


125, 


145. 325 


Haemorrhois 


. 


«... 


86, 


I03, HO 


Hallucinatio . 




• • • • 


. 


101, 127 


Hectica 


. 


• . . 




95, IO9 


Helminthia 




• • • . 


". 


133 


Hemicrania 


• 


• • • • 




IOO 


Hemiplegia 




* 


. 


99 


Hepatalgia 


. 


. 




IOI 


Hepatirrhoea 




• • • • 


. 


103 


Hepatitis 


. 


. 96, 


109, 


123, 142 


Hepatocele 




• • • • 


. 


93 


Hernia 


. 


• • • • 




116, 128 


Herpes 




86 


,.9*. 


116, 162 


Hidroa 


• 


• • • 




91 


Hippocrates, diseases 


> upon which he has written 


. 


82-91 


Hordeolum 


• 


«... 




92, 141 


Hosack's system 




« • « « 


. 


166 


Hydatis 


. 


• . 




93. n6 


Hydrarthrus . 




• • • « 


93, 


116, 144 


Hydrocele 


. 


. 




113. 128 


Hydrocephalus 




• • • • 


• 


105, 112 


Hydrogeneses 


• 


• • • • 




. 119 


Hydrometra . 




• • • • 


. 


105, 113 


Hydrophobia 


• 


• • • • 




102, 112 


Hydrops 




• • • • 


. 


160 


Hydrorhachitis 


• 


• • • 




105, 112 


Hydrothorax 




• • • • 


. 


98, 113 


Hygiene 


• 


• • • • 




• 35 


Hyperaemia . 




• • • • 


• 


45» 254 


Hyperaestheses 


. 


# • 




. 108 


Hyperalonaemia 




« « • • 


• 


45> 259 


Hypercholesteraemia 


• • • • 




46, 266 



INDEX. 



395 



Hyperchromataemia 

Hypererythrocythaemia 

Hyperglycaemia 

Hyperinosaemia 

Hyperhydraemia 

Hyperleucocythaemia 

Hyperleucontaemia 

Hyperlipaemia 

Hyperphysaemia 

Hypersarcosis 

Hypertrophy and Hypotrophy 

Hyperuraemia 

Hyperuricaemia 

Hypoaemia 

Hypoalonaemia 

Hypocholesteraemia 

Hypochondriasis 

Hypochromataemia 

Hypoerythrocythaemia 

Hypoglycaemia 

Hypohydraemia 

Hypoinosaemia 

Hypoleucocythaemia . 

Hypoleucontaemia 

Hypolipaemia . 

Hypophysaemia 

Hypostophyle 

Hypouraemia 

Hysteralgia . , 

Hysteria 

Hysteritis 

Hysterocele 

Hysteroloxia 



45- 259 
46, 261 
46, 263 
45- 257 

45. 257 

46, 260 

45, 258 

46, 262 
46, 262 

. 86 

53- 55. 326 
46, 265 
46, 265 
45. 255 

45. 259 

46, 266 
101, III 

46, 260 
46, 261 
46, 264 

45. 257 

45, 258 

46, 261 
45» 259 
46, 262 
46, 262 

93 
46, 265 
ior 
97. 112 
10 124, 143 

• 93 
93 



Hysteroptosis 


a.XHXJJBiJ%.t 


93 


Icterus 


. 


113. 134 


Icthyiasis 




162 


Ileus 


. 


103, 132 


Impetigines 




105, 113 


Impetigo 


. 


127, 163 


Impotens 




87, 156 


Infiltration 


. 


48, 328 


Inflammation 




47, 51, 52, 123 


Inoma 


• 


48, 371 


International Medical Congress, 




questions suggested for discussion by 


244 


Intumescentiae 


. . • 


. IO4, 112, 128 


Ionthus 


.... 


141 


Ischaemia 


. . 


47, 323 


Ischias 


• . • 


IOI 


Ischuria . 


.... 


105, 115, 125 


L<agne§is 


* 


156 


Laryngismus 


. 


. 137 


Laryngitis 


».•■•*• 


142 


Lassitudo 


.... 


IOO 


Laxarthrus 


.... 


94 


Leiomyoma 


. 


49, 372 


Leipopsychiae 


. 


99 


Leipothymia 


. 


99 


Leontiasis 


«... 


105 


Lenticula 


. . . 


.164 


Lepidosis 


. 


162 


Lepra 


. 


. 49,io5,U3 


Lepriasis 


• . • . 


162 


Leprosy . 


• . . . 


. 87 


Lethargus . 


. 


• 99, 154 


Lethargy 


• 


. 87 



INDEX. 



397 



Leucaemia 


, 


. 


260 


Leucasmus 


> • • 


, . 


164 


Leucoma 


, , 


• i 


91 


Leucomnines 


• • 


. , 


286-296 


Leucophlegmatia 


. 


. 


87 


Leucorrhoea 


. 


104, 


124, 155 


Leucorrhois . 


, . 


* • 


124 


Leucoses 


. . . 


, , 


. 165 


Lichen 


. , 


. 


162 


Lienteria . 


. 


87, 


103, 133 


Limosis 


. 


. 


131 


Lipoma 


. 


. 


48, 334 


Lissa . 


. 


. 


152 


Lithia 


• • • 


, , 


. 161 


Lordosis 




. . . 


92 


Loxia 


. . 


. 


. 152 


Lues 




• . ■ 


146 


Lumbago . 


• • 


. 


. 101 


Lupia . 






93. 115 


Luxatio 


. 


87, 


116, 128 


Lymphangioma 




. 


49> 372 


Lymphexosmosis 


■ . 


. 


47. 325 


Lymphorrhagia 




• • • 


47, 325 


macbride'§ system 


. 


. 117 


Macies 




• • • 


104 


Maculae 


. 


. , 


91, 127 


Madness 




• • . 


87 


Malasicterus 


• • • 


, , 


. 106 


Malis . 






105, 163 


Mania 


. . • 


102, 


112, 148 


Marasmus 




• • • 


145 


Marcores 


. • . 


, . 


112 


Marisca 






93, 134 



39» 



INDEX. 



Mastodynia 


IOI 


Means . 


• .135 


Medicine, definition of 


29 


, classification of 


31 


and surgery 


39 


Meiosis . 


. 48, 54, 327 


Melaena 


103, 134 


Melanaemia 


46, 267 


Melancholia 


87, 102, 112, 148 


Melasma . 


. 127 


Membranaceae 


96 


Menorrhagia 


103, no 


Mentales 


107 


Mesotica 


• 159 


Metamorphoses, retrograde 


48 


Meteorismus 


105 


Metritis 


96 


Miliaria . 


95, no, 144 


Milium 


162 


Monsters . 


. 50 


Moria .... 


149 


Morbositas 


127 


Morositates 


102 


Motorii 


108 


Mutitas 


. 99. "4 


Myoma , 


49. 372 


Myxoma 


48 


Nausea . 


103 


Necrosis 


48, 106, 147, 327 


Neoplasmata 


48, 49, 328-372 


Nephralgia . . , 


IOI 


Nephritis . . . , 


96, no, 123, 142 


Neuralgia 


151 



INDEX 



Neuroglioma 

Neuroma 

Neuroses 

Neurotica 

Nictitatio 

Nomenclature, character of 

Nosography, origin of 

Nostalgia 

Nyctalops 

Nymphomania . 

Nystagmus 

Ob§tipita§ 

Obstipatio 

Obstruction 

Odontalgia . 

Odontia . 

Oedema 

Oneirodynia 

Ophthalmia 

Opisthotonos 

Oppressivae 

Orchitis 

Organ, definitioifof 

Orgastica 

Orthopnea 

Oscedo 

Oscheocele . 

Osteoma 

Osthexia 

Ostocopus . . 

Otalgia 

Otitis 

Otorrhoea 



399 

48,371 
49. 372 
in 
148 
152 
227 

• 74 
102, 114 

. 88 
102, 114, 127 

• 97 
96 

. 115. 125 

■ 49» 57 

100, no, 124 

130 

. 92 
112 

100, 109, 123, 143. 
. ' 88 
. 98 
143 
. 63 
. 156 
88, 98 
97 

• 93 
48 

160 
100 
100 
142 
104 



400 



INDEX. 



Oxygeneses 
Palpitatlo 

Pandiculatio 

Panophobia 

Parabysma 

Paracusis 

Paracyesis 

Parageusis 

Paraglossa 

Paralysis 

Paramenia 

Paramorphiae 

Paraneurismi 

Paranoiae 

Paraphonia 

Paraphrenitis 

Paraphlegia 

Paraphrosyne 

Parapsis 

Parasites 

Pareccrises 

Parenchymatosae 

Parhaemasiae 

Paristhmitis 

Parodynia 

Paroniria 

Paronychia 

Paropsis 

Parorchydium 

Parosmis 

Parostia 

Parotis 

Parotitis . 





. 


119 


97, 


in 


,152 




97 


152 
102 




. 


135 


98, 


113 


150 

157 

151 

93 


99, 


in, 


154 


• 




154 
129 
129 


. 


108, 


127 


~ 


99» 


114 
96 




• 


99 
102 


. 


• 


151 

5o 


. 


• 


129 
96 




• 


129 
142 




• 


158 
149 


• 


92, 


141 
149 

93 
150 


1 


• 


159 

92 




. 


142 



INDEX. 



401 



Parr's rules . 


185 


Parr's system 


122 


Paruria 


161 


Pathengenetic and pathogenetic 


56, 326 


Pathology 


34 


Pemphigus 


. 95, no, 144 


Periostea 


124 


Peripneumonia 


88, 96 


Peritonitis 


109, 142 


Pernio .... 


142 


Pertussis 


in 


Pestis .... 


. 95, no, 145 


Petechia 


127 


Phaenigmus 


106, 127 


Phallic worship 


26 


Phimosis 


92 


Phlegmasia . 


47, 52 


Phlegmasiae 


87»95» 109, ii7. 123 


Phlegmatia 


104, 128 


Phlegmon 


. 123 


Phlegmone 


92, 140 


Phlogistici 


107 


Phlogosis 


109, 124 


Phlogotica 


140 


Phlyctaenae . 


88 


Phlysis .... 


141 


Phonica 


136 


Phosphoreneses 


119 


Phrenica 


148 


Phrenitica 


124 


Phrenitis 


88, 96, 109, 123 


Phthinasis 


106 


Phthisis 


104, no, 124, 146 



402 



INDEX. 



Phyma 

Physconia 

Physician, the ideal 

Physocephalus 

Physometra 

Pica . 

Pinel's system 

Pityriasis 

Plagae 

Plague 

Plethora . 

Pleuralgia 

Pleurisy . 

Pleuritis 

Pleurodyne 

Plica . 

Pneumatica 

Pneumatosis 

Pneumonia 

Pneumonica 

Pneumonitis 

Pneumoses 

Podagra . 

Poecilia 

Polypus 

Polydipsia 

Polysarcia 

Pompholyx 

Porphyra 

Porrigo 

Priapismus 

Proctalgia 

Proctica . 





92, I4r 


• 


104, 113 




42 


. 


105 




105, 112 


1 02, 


114, 132 




. 118 


a 


162 


. 94, 


117, 128 


. 


8Sr 




145, 254 


. 


138 




88 




96, 142 




. 98 


• • 


163 




. 136 


• 


104, 112 




109, 123 




124, 137 




142 


. 


165 




no, 144 


. 


164 


. 88, 


125, 136 


. 


102, 114 


104, 


112, 159 




162 




• 147 


. 


163 


. 96, 


126, 152 


» 


IOI 




. 134 



INDEX. 



403 



Procotica 

Profluvia 

Profusio 

Prolapsus 

Prophylaxy 

Proptoma 

Prurigo 

Pruritus 

Psellismus 

Pscudoblepsis 

Pseudocyesis 

Psora 

Psoriasis 

Psydracia 

Pterygium 

Ptomaines 

Ptyalismus 

Pudendagra 

Puerperalis 

Punctura . 

Purpura 

Pyosapraemia 

Pyretica 

Pyrexiae 

Pyrosis 

Pyuria 

Quietales 

Quinsey 

Raige-Delorme'§ 

Raphania . 

Rdcamier's system 

Rhabdomyoma 

Rhachia 



system 



156 

108, 125 

"5 
116, 128 

35 

93 

162 

100 

99. "4, 137 

• 113 
158 
116 
162 

9i 

,92 

267-286 

103. 115, 131 

101 

124 

• 94 
95 

46, 297 

139 

109, 123 

IOO, III 

. 104 
108 

. 8 9 
166 

53 
121 

49. 372 
159 



in 



404 



INDEX. 



Rhachialgia 

Rhachitis 

Rhagas .... 

Rheum 

Rheuma .... 

Rheumatismus 

Rhinoscleroma 

Rhonchus 

Rhypia .... 

Richerand's system 

Rigor .... 

Rosalia 

Roseola .... 

Royal Coll. of Phys. of London 

Rubeola ..... 95, 

Rubigo 

Rubula .... 

Rules for the guidance of the nosographer 

Ruptura .... 

Sagar'§ system 

Salacitas , 

Salax .... 

Sanguifluxus 

Sarcoma . . . .48, 92, 

Satyriasis .... 

Sauvages, notice of 

Savignac's system 

Scabies 

Scarlatina .... 

Scelotyrbe 

Sciatica, .... 

Scirrhus ..... 

Scorbutus ..... 105, 



"5. 
102. 



INDEX. 



40S 



Scrophula 

Scurvy 

Scybalum 

Selle's system 

Septicaemia 

Serifluxus 

Singultus 

Sinus 

Somnambulismus 

Spasmi 

Spasmodicae 

Specific differences 

Spermorrhoea 

Sphacelus 

Spilus 

Splanchnica 

Splenalgia 

Splenitis 

Splenocele 

Staphyloma 

Stark's system 

Stenosis 

Sternalgia 

Sternutatio . 

Stertor 

Stomacace 

Stones . 

Strabismus 

Strangury 

Stricture 

Strophulus 

Struma 

Stupor 



96; 



108 



96 



• 


105, 


113 

89 

i33 
117 




46, 


267 
103 




98, 


152 

94 
101 


III, 


117. 


126 
97 


• 




194 
155 


89, 


109, 


H7 
164 


• 




134 
101 


96, 


no, 


142 
93 


• 


93. 


150 
173 


. 


48, « 






138 


. 


97, 


152 


89, 98, 


136 






103 




50, 89 


114. 


126, 


150 
89 


. 


48, 1 






162 


• 




146 




• 


100 



406 



INDEX. 



Suffusio 

Supercalorineses 

Superoxygeneses 

Suppressions 

Suppressorii . 

Surditas . 

Swediaur's system 

Sycosis 

Synclonus 

Syncope 

Synocha 

Synochus 

Synonyms 

Synopsis of Cullen 

Synopsis, of morbid states 

Syphilis 

Syphilodes 

Syrogmos 

Systatica 

Systremma 

Tabes 

Tabes dorsales 

Tarantismus . 

Tenesmus 

Teratology 

Terminthi 

Tetanus 

Tetartophya 

Therapy . 

Thrombosis 

Tinea 

Tonici generales 

Tonici partiales 



etc 



49- 



90, 





- • 




IOI 

119 




• 




119 

117 






108 


, 125 
150 




• 




129 

141 




. 




153 






99 


. in 




94. 


109 


123 


94, 109, 


123 


140 




. 




198 






. 


109 




. 




45 


105, 


113. 


127, 


146 




. 




146 


• 




• 


IOI 

153 


. 




. 


152 




104, 


112, 


146 


• 




. 


90 




. 




102 




90, 


IO3, 


134 
34 


. 




. 


90 


97, 


in, 


126, 


152 


. 




. 


95 




. 




36 


• 




47. 


325 






105, 


116 


• 




. 


97 




. 




96 



INI 


)EX. 407 


Tourdes* system . 


, . .120 


Tourtelle's system 


121 


Tricoma 


106 


Trichosis 


. 90, 163 


Tremor 


97. HI, 153 


Trismus . . , 


96, in, 126, 152 


Tritacophya 


. 95 


Trophopathies • 


165 


Tuber 


. 128 


Tubera . • , 


105 


Tuberculosis 


. 49 


Turns 


98 


Tumors . . . 


. 90 


Tympanites 


. 105, 112 


Typhomania 


. 99 


Typhus, 


95, 109, 123, 140 


Ulceration 


. 48 


Ulcers 


90 


Ulcus 


. 94. n6, 147 


Uroses 


165 


Urticaria . 


no, 144 


Vaccinia 


144 


Vagi 


100 


Varicella 


no, 144 


Varieties . 


. 198 


Variola 


95. IIO » H5 


Varix . 


90,92,115,147 


Verruca 


92, ll 5' l6 3 


Vertigo 


91, 101 


Vesaniae 


101, 112, 117, 127 


Vitet's system 


. 117 


Vitia . 


91 108, 117 


Vitiligo 


. 91 



408 INDEX. 

Vomica ..... 109, 140 

Vomitus ....... 103 

Vulnus . . • • . 94, 116 



Angell's Printing Office, 354 Fourth Ave., N. Y. 



409 



WORKS BY THE SAME AUTHOR. 



A CASE OF polypus OF THE larynx. — Tracheotomy to 
prevent impending suffocation ; laryngo-tracheotomy ; 
recurrence of the disease ; operation repeated; recovery. 
New York Medical Journal, September 1867. 

On external perineal urethrotomy, or an improved 
method of external division of the urethra in perinaeo 
for the relief of obstinate stricture, etc. Transactions of 
the Medical Society of the State of New York, 1869. 
New York Medical Journal, August 1869. Reprinted 
in pamphlet form, pp 32. 

Instruments for exploration of the urethra, — 
Difficult catheterism, etc. Medical Record. March 15th, 
1870. 

Treatment of intractable (urethral) strictures. — 
Divulsion and divulsors, etc. Medical Record. April 1st, 
1870. 

On internal urethrotomy. Medical Record. April 
15th, 1870, 

Strictures at the meatus urinarius, and in the fossa 
navicularis. Their nature, diagnosis and treatment. 
Medical Record. May 2d, 1870. 

On modern lithotripsy. Medical Record. October 1st, 
1870. 



4io 

Urethral fever from catheterism, its nature and treat- 
ment. Medical Record. October 1st, 1872. 

Case of retention of urine caused by a single, diseased 
kidney, situated in the pelvic cavity, for the relief of 
which rectal puncture was done. The trocar passing to 
the right of the bladder and entering the kidney. Death 
on the fourth day after the operation. Autopsy. Re- 
marks. Medical Record. October 15th, 1872. 

Rupture of the bladder from retention of urine due to 
stricture of the urethra. With cases and remarks. 
Medical Record. November 1st, 1872. 

Diseases of the urinary organs, including stricture of 
the urethra, affections of the prostate and stone in the 
bladder. 1873. 8vo pp 368. 

Perityphlitic abscess due to perforation of the appendix 
vermiformis, with remarks on the surgical treatment 
thereof. Transactions of Medical Society of the State of 
New York, 1875. Virginia Medical Monthly. March 
1875. Pamphlet pp 9. 

Treatment of chronic cystitis. Abstract of a paper 
read on this subject to the Medical Society of King's 
County, New York. Medical Record. October 30th, 
1875. 

Urethroplasty operations to remedy hypospadias, 
epispadias and incurvation of the penis. Medical Record. 
February 19th, 1876. Pamphlet pp 15. 



4U 

Stone in the bladder, its spontaneous expulsion and its 
removal by lithotripsy, lithotomy and perineal lithotrity, 
with an analysis of thirty-five cases. Abstract of paper 
read to Medical Society of the State of New York, June 
1876. Medical Record. July 8th, 1876. 

Report of a case of sub-periosteal excision and dis- 
articulation of the entire inferior maxillary bone for 
phosphorous necrosis. Pamphlet pp 6. Extracted from 
the Transactions of the International Medical Congress, 
Philadelphia. September 1876. 

Amputation of the penis. Cases illustrative of the man- 
agement of the extremity of the urethra after amputation 
of the penis close to the pubes. Louisville Medical 
News. September 15th, 1877. 

Retention of urine in elderly men. Acute retention 
of urine. Medical Record. August 23rd, 1879. 



Internal urethrotomy and lithotripsy at the same sit- 
ting, etc. With remarks on rapid lithotripsy, and on the 
evacuation of detritus from the bladder. Pamphlet pp 16. 
Reprinted from the Medical Record. October 1 8th, 
1879. 

Note on cystorrhagia from retention of urine. Pamphlet, 
pp 15. Reprinted from the Transactions of the Medical 
Society of the State of New York for 1880. and published 
in the Medical Record. February 21st, 1880. 



J *J£L 




412 

Chronic retention of urine in elderly men. Pro- 
ceedings of the Medical Society of the County of 
Kings. Vol. VI, January 1882. 

A clinical contribution to lithoclastic cystotomy, with 
eleven illustrative cases. The Medical Gazette. New 
York, June 2d, 1883. 

Report of a case of ligature of the right prim- 
itive iliac artery for diffuse aneurism of the external 
iliac ; death from pyaemia on the twenty-first day. 
Transactions of the New York State Medical Association. 
1884. 

Some points in the surgery of the hypertrophied 
prostate. Transactions of the American Surgical 
Association. 1885. 

Notes on contracture of the bladder consequent 
upon cystitis. Transactions of the New York State 
Medical Association. 1885. 

Sacculation and perforation of the bladder as 
consequences of chronic retention of urine. Pamphlet 
pp 14. Reprinted from the Transactions of the New 
York State Medical Association. 1886. 



